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Y2K AND MEDICAL DEVICES: TESTING FOR THE

Y2K BUG

JOINT HEARING
BEFORE THE

SUBCOMMITTEE ON
HEALTH AND ENVIRONMENT
AND THE

SUBCOMMITTEE ON
OVERSIGHT AND INVESTIGATIONS
OF THE

COMMITTEE ON COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTH CONGRESS
FIRST SESSION

OCTOBER 21, 1999

Serial No. 10669

Printed for the use of the Committee on Commerce

(
U.S. GOVERNMENT PRINTING OFFICE
60362CC WASHINGTON : 1999

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COMMITTEE ON COMMERCE
TOM BLILEY, Virginia, Chairman
W.J. BILLY TAUZIN, Louisiana JOHN D. DINGELL, Michigan
MICHAEL G. OXLEY, Ohio HENRY A. WAXMAN, California
MICHAEL BILIRAKIS, Florida EDWARD J. MARKEY, Massachusetts
JOE BARTON, Texas RALPH M. HALL, Texas
FRED UPTON, Michigan RICK BOUCHER, Virginia
CLIFF STEARNS, Florida EDOLPHUS TOWNS, New York
PAUL E. GILLMOR, Ohio FRANK PALLONE, Jr., New Jersey
Vice Chairman SHERROD BROWN, Ohio
JAMES C. GREENWOOD, Pennsylvania BART GORDON, Tennessee
CHRISTOPHER COX, California PETER DEUTSCH, Florida
NATHAN DEAL, Georgia BOBBY L. RUSH, Illinois
STEVE LARGENT, Oklahoma ANNA G. ESHOO, California
RICHARD BURR, North Carolina RON KLINK, Pennsylvania
BRIAN P. BILBRAY, California BART STUPAK, Michigan
ED WHITFIELD, Kentucky ELIOT L. ENGEL, New York
GREG GANSKE, Iowa THOMAS C. SAWYER, Ohio
CHARLIE NORWOOD, Georgia ALBERT R. WYNN, Maryland
TOM A. COBURN, Oklahoma GENE GREEN, Texas
RICK LAZIO, New York KAREN MCCARTHY, Missouri
BARBARA CUBIN, Wyoming TED STRICKLAND, Ohio
JAMES E. ROGAN, California DIANA DEGETTE, Colorado
JOHN SHIMKUS, Illinois THOMAS M. BARRETT, Wisconsin
HEATHER WILSON, New Mexico BILL LUTHER, Minnesota
JOHN B. SHADEGG, Arizona LOIS CAPPS, California
CHARLES W. CHIP PICKERING,
Mississippi
VITO FOSSELLA, New York
ROY BLUNT, Missouri
ED BRYANT, Tennessee
ROBERT L. EHRLICH, Jr., Maryland
JAMES E. DERDERIAN, Chief of Staff
JAMES D. BARNETTE, General Counsel
REID P.F. STUNTZ, Minority Staff Director and Chief Counsel

SUBCOMMITTEE ON HEALTH AND ENVIRONMENT


MICHAEL BILIRAKIS, Florida, Chairman
FRED UPTON, Michigan SHERROD BROWN, Ohio
CLIFF STEARNS, Florida HENRY A. WAXMAN, California
JAMES C. GREENWOOD, Pennsylvania FRANK PALLONE, Jr., New Jersey
NATHAN DEAL, Georgia PETER DEUTSCH, Florida
RICHARD BURR, North Carolina BART STUPAK, Michigan
BRIAN P. BILBRAY, California GENE GREEN, Texas
ED WHITFIELD, Kentucky TED STRICKLAND, Ohio
GREG GANSKE, Iowa DIANA DEGETTE, Colorado
CHARLIE NORWOOD, Georgia THOMAS M. BARRETT, Wisconsin
TOM A. COBURN, Oklahoma LOIS CAPPS, California
Vice Chairman RALPH M. HALL, Texas
RICK LAZIO, New York EDOLPHUS TOWNS, New York
BARBARA CUBIN, Wyoming ANNA G. ESHOO, California
JOHN B. SHADEGG, Arizona JOHN D. DINGELL, Michigan,
CHARLES W. CHIP PICKERING, (Ex Officio)
Mississippi
ED BRYANT, Tennessee
TOM BLILEY, Virginia,
(Ex Officio)

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SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
FRED UPTON, Michigan, Chairman
JOE BARTON, Texas RON KLINK, Pennsylvania
CHRISTOPHER COX, California HENRY A. WAXMAN, California
RICHARD BURR, North Carolina BART STUPAK, Michigan
Vice Chairman GENE GREEN, Texas
BRIAN P. BILBRAY, California KAREN MCCARTHY, Missouri
ED WHITFIELD, Kentucky TED STRICKLAND, Ohio
GREG GANSKE, Iowa DIANA DEGETTE, Colorado
ROY BLUNT, Missouri JOHN D. DINGELL, Michigan,
ED BRYANT, Tennessee (Ex Officio)
TOM BLILEY, Virginia,
(Ex Officio)

(III)

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CONTENTS

Page
Testimony of:
Benson, James S., Executive Vice President for Technology and Regu-
latory Affairs, Health Industry Manufacturers Association; accom-
panied by Bernie Liebler, Director, Technology and Regulatory Affairs .. 48
Grob, George, Deputy Inspector General, Department of Health and
Human Services ............................................................................................ 26
Horowitz, Bruce, Director of Product Assurance, Advanced Neuro-
modulation Systems, Inc .............................................................................. 53
Hubbard, William K., Senior Associate Commissioner for Policy, Planning
and Legislation, accompanied by Thomas Shope, Special Assistant to
the Director, Office of Science and Technology, U.S. Food and Drug
Administration .............................................................................................. 7
Neill, C. Thomas, Vice President of Corporate Services, Quorum Health
Group ............................................................................................................. 57
Willemssen, Joel C., Director, Civil Agencies Information Systems, Ac-
counting and Management Division, General Accounting Office ............. 14

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Y2K AND MEDICAL DEVICES: TESTING FOR
THE Y2K BUG

THURSDAY, OCTOBER 21, 1999

HOUSE OF REPRESENTATIVES,
COMMITTEE ON COMMERCE,
SUBCOMMITTEE ON HEALTH AND ENVIRONMENT, AND
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS,
Washington, DC.
The subcommittees met, pursuant to notice, at 10 a.m. in room
2123, Rayburn House Office Building, Hon. Fred Upton, Chairman,
Subcommittee on Oversight and Investigations and Hon. Michael
Bilirakis, Chairman, Subcommittee on Health and Environment,
presiding.
Members present Subcommittee on Health and Environment:
Representatives Bilirakis, Upton, Greenwood, Deal, Burr, Bryant,
Brown, Green, and Barrett.
Members present Subcommittee on Oversight and Investigations:
Representatives Upton, Bryant, and Green.
Staff present: Lori Wall, majority counsel; John Manthei, major-
ity counsel; Chris Knauer, minority investigator; and Amy Davidge,
legislative clerk.
Mr. UPTON. Good morning, everyone. As they say in Ann Arbor,
welcome to the big house.
Today the Subcommittee on Oversight and Investigations and
the Subcommittee on Health and the Environment are holding a
joint hearing on the issue of the Year 2000 problem as it relates
to medical devices. Over the past year, the Committee on Com-
merce has undertaken an extensive review of the progress that the
Health Care Financing Administrations Medicare contractors and
its hospitals, nursing homes, doctors and other providers have
made in becoming Y2K compliant.
Earlier this year, these two subcommittees held hearings on the
Y2K status of computer billing and financial systems as well as the
Y2K compliant status of medical devices. Today, our hearing will
follow up on the progress that the FDA, as well as the medical de-
vice manufacturers in hospitals, have made in ensuring the Y2K
compliance of medical devices.
Medical devices and equipment such as cardiac monitoring sys-
tems, cardiac defibrillators and x-ray machines are critical to pro-
viding health care treatment in a variety of health care settings.
These devices have the potential to adversely affect patient safety
if they perform any type of date or time calculation. The degree of
risk increases significantly if the machine is a critical care or life
support device.
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In 1997, the FDA began collecting data from device manufactur-


ers regarding Y2K compliant status of their devices. After several
letters and a small response rate from the manufacturers, the FDA
joined in partnership with the VA, the Department of Defense and
Health Industry Manufacturers Association to assemble a single
database clearinghouse. The goal of the clearinghouse was to pro-
vide a centralized source of information on the Y2K compliance sta-
tus of biomedical equipment in the U.S.
Since FDA began its database, the flow of information has in-
creased significantly. However, the FDA is not ensuring that the
information displayed on their clearinghouse is accurate or com-
plete. In other words, the clearinghouse serves as a central point
for data, but not a guarantee by the FDA that the data provided
is accurate or complete.
In order to assess the reliability of the information submitted to
the clearinghouse, the FDA announced at our last hearing that
they would develop a list of potentially high risk devices that could
cause serious consequences for the patient if they were to fail be-
cause of data related problems. The FDA would then identify those
domestic and foreign manufacturers that have high risk devices for
marketing in the U.S. and hire third party contractors to perform
onsite visits to a random sample of manufacturers. The contractors
would assess the manufacturers procedure and records, both for
Y2K assessment of potentially high risk devices and for validation
of any Y2K corrections made to those devices. We will hear today
about the results of that study.
While information regarding the Y2K status of medical devices
continues to increase, recent surveys from the HHS Office of In-
spector General show that less than half of Medicare fee for service
providers who responded to their survey reported that all of their
biomedical equipment was Y2K ready. Although more than 90 per-
cent of all providers who responded to the survey reported that
their biomedical equipment will be completely ready by December
31st, there obviously is work remaining.
I hope that this hearing will demonstrate the need for all health
care providers to ensure that their medical devices are Y2K compli-
ant. It is crucial at the turn of the century that service to Medicare
beneficiaries is uninterrupted, and that patient safety will never be
jeopardized. The news we will hear today will not doubt be more
encouraging than what we heard a few short months ago.
However, we must remain committed to ensuring that medical
devices, particularly those that are potentially high risk devices,
will be Y2K ready as we enter the new year.
I would like to welcome all of our panelists that are here to tes-
tify. Thank you for coming. At this point, I yield to the ranking
member of the Health Subcommittee, Mr. Brown.
Mr. BROWN. Thank you, Mr. Chairman. I am pleased to partici-
pate in our third joint hearing on Y2K issues. I would like to thank
our distinguished panelists for joining us and thank Chairman
Upton and Chairman Bilirakis for calling this hearing. I will keep
my remarks brief.
The purpose of todays hearing is to get a progress report on ef-
forts to forestall Y2K related problems affecting patients. I under-
stand it remains difficult to assess Y2K preparedness on the part

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of hospital and physician providers, due in part to low survey re-


sponse rates from those providers. I am interested in hearing the
views of our witnesses on the significance of this information gap,
and what if anything is being done at this point to remedy it.
I look forward to an update from FDA and the medical device in-
dustry on their progress in their potential areas of concern. I think
it would be useful to hear our witnesses views on what is most and
what is least likely to go wrong, and most importantly, to get a feel
for your public awareness efforts and other strategies you plan to
deploy as we move closer to Y2K.
Finally, I want to commend the FDA and those in the industry
and health care communities who have made good faith efforts to
resolve the publics concerns regarding Y2K. The product of your ef-
forts will hopefully contribute to a blessedly uneventful New Years.
I thank you, Mr. Chairman.
Mr. UPTON. I yield to the chairman of the Health and Environ-
ment Subcommittee, Mr. Bilirakis from Florida.
Mr. BILIRAKIS. I thank the gentleman, and it is so very nice to
be able to agree 100 percent with the ranking members opening
statement. It is a rarity, I am afraid.
Mr. Chairman, I am pleased that we have again reconvened our
two subcommittees to examine the readiness of medical devices and
ensure that the delivery of health care will not be impacted by the
arrival of the new century. And I, too, would like to welcome all
of our witnesses who have taken the time to share their expertise
on these important issues.
I believe that it is critical, as others have said, that we work to-
gether to convey a sense of security to the American people. The
Y2K issue has received a great deal of publicity. Many Americans
have expressed a sense of uncertainty and are seeking assurances
that the new millennium will be a cause for celebration and not
concern.
At the same time, we must convey a sense of urgency to mem-
bers of the health care community. Any failed medical device is one
too many. And 100 percent compliance is the only acceptable goal.
In our first panel, the FDA will update us on the Y2K readiness
of biomedical equipment. Medical devices play a critical role, as we
know, in the daily delivery of health care. And as most of us know,
these can range from basic thermometers to more complex devices
such as electrocardiograms and infusion pumps. If devices that uti-
lize computer software fail to operate or give improper readings,
patients all over the country and the world may be put at an un-
necessary risk.
The FDA will describe the progress it has made on this issue
since our hearing earlier this year. I also look forward to hearing
from GAO and the HHS Office of the Inspector General.
Our second panel will describe the steps taken by individual hos-
pitals and device manufacturers to address the unique challenges
posed by the Y2K problem. Manufacturers are often the only par-
ties that have complete access to all of the design and operating
parameters of an individual device. Therefore it is essential to
know what is being done by medical device manufacturers to en-
sure that computer software will operate properly without interrup-
tion.

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I was particularly impressed by the testimony we received at our


last hearing. I look forward to learning more from our witnesses
today about the specific steps they have taken to ensure that pa-
tients will not be put at risk.
In that regard, Mr. Chairman, I would just like to communicate
that I was very pleased to learn of the efforts of Tampa General
Health Care, which serves many of my constituents in the Tampa
Bay area. As of yesterday, Tampa General Hospital had individ-
ually tested more than 5,700 pieces of equipment crucial to deliv-
ering uninterrupted health care.
In so doing, it was able to report 100 percent compliance of res-
piratory therapy equipment, 97 percent compliance of biomedical
devices and facilities, and 82 percent compliance for radiology
equipment. Furthermore, I was assured that any equipment that is
not determined to be Y2K compliant by December 15th will be re-
moved from service.
So again, I want to thank all of our witnesses for joining us and
I yield back the balance of my time. Thank you, Mr. Chairman.
Mr. UPTON. Thank you, Mr. Chairman. I yield to the gentleman
from Tennessee, Mr. Bryant.
Mr. BRYANT. Thank you, Mr. Chairman.
And I do thank both of my chairmen, with whom I serve on the
two committees that are conducting this joint investigation. I ap-
preciate very much your holding this hearing today.
Mr. Chairman, if you walk down Pennsylvania Avenue just past
the Library of Congress, there is an interesting display in the front
window of one of our local shops. It has a digital clock which counts
down the actual days, hours, minutes, seconds, I think even micro-
seconds, before the end of the millennium. Standing in front of the
rapidly moving numbers gives one a strange sense of urgency, and
maybe even a hint of concern about what will happen when the dis-
play finally reads zero across all of the numbers.
I think the clock is meant to persuade you to buy your New
Years Eve champagne before supplies run out. But it does serve
an important reminder to all of us that New Years Eve may be a
little different than our past celebrations.
Talk to 10 different people and you will probably get 10 different
answers about what will happen at 12:01 on January 1, 2000. The
answers can be as extreme as the end of the world, or as mild as
a possible shortage of aspirin and Rolaids for those who have been
over-served the night before. Personally, I do not have any pre-
dictions, but I am glad to see for the most part our schools and
businesses and Government institutions have taken a very serious
approach on the problem.
And likewise in Washington, we have actually passed a liability
bill as concerns Y2K problems that might come up. Certainly with
an interest in trying to remediate those types of concerns. But in
the health care industry, we face a little different situation, that
we are simply not dealing with business records and those kinds
of things that we are concerned about in the general commerce, but
we are dealing with potential human life here. So I think it is very
important that we take a serious approach to this and as GAO has
pointed out in the past, the question of whether medical devices,
such as MRIs, x-ray machines, pacemakers, and even fetal mon-

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itors, can be counted on to work reliably after the stroke of mid-


night on December 31st is of critical importance to our Nations
health care system.
While I am glad to see the FDA has been working over the past
couple of years to ensure compliance of our medical devices, I do
have some questions regarding the FDA approval process and the
Y2K problem. I would be interested in knowing how and when the
FDA incorporated the millennium bug into its approval process.
For instance, GAO lists several devices as high-risk, including the
implantable pacemaker, pulse generator and the implanted cere-
bral stimulator. When, if ever, did such devices have Y2K compli-
ance in order to gain approval? At what point could FDA and the
device manufacturers, for that matter, know that the year 2000
could pose a serious health risk? And when did the FDA act upon
this knowledge?
In the short, we should all be focusing on ensuring that our med-
ical equipment and facilities will be functioning normally in Janu-
ary. But we should not ignore the long-term questions regarding
how this problem might have been prevented. And I thank the
Chair again for holding this hearing, and look forward to hearing
from our two distinguished panels, including an expert witness, a
truly expert witness, because he is from Tennessee, Mr. Neill, who
is with Quorum Resources Group in Nashville, Tennessee. I wel-
come him and again, the other distinguished witnesses that will be
testifying in the two panels before us today.
Thank you.
Mr. UPTON. Thank you very much.
I would note to the audience that we have a number of sub-
committee and full committee meetings going on this morning, and
the House is in session, so members will be coming in and out. At
this point, I would ask unanimous consent that all members may
enter their opening statement as part of the record, by unanimous
consent.
[Additional statements submitted for the record follow:]
PREPARED STATEMENT OF HON. TOM BLILEY, CHAIRMAN, COMMITTEE ON COMMERCE
For the past year, this Committee has conducted an in-depth look at the health
care industry and its efforts to become ready for the Year 2000.
This Committee has received regular updates on the progress the Department of
Health and Human Services and industry has made in addressing their Y2K prob-
lems. The subcommittees on Oversight and Investigation and Health and the Envi-
ronment held two previous hearings on Y2K readiness as it relates to health care.
Today, we are holding a follow-up hearing to determine the Y2K status of bio-
medical equipment, specifically critical care and life support devices. Medical devices
are critical to medical treatment and research in both our federal as well as our pri-
vate sector health care facilities. Any equipment that performs a date or time cal-
culation is potentially susceptible to the Y2K bug.
Since this process began over two years ago, much progress has been made with
regards to Y2K readiness. However, work remains to be done. For example, a recent
survey conducted by the Health and Human Services Office of Inspector General
stated that only 27 percent of hospitals who responded to their survey reported that
their biomedical equipment was Y2K ready. Although most hospitals reported that
they intend to be Y2K compliant by the Year 2000, only time will tell.
I hope this hearing will allow us all to gain a better insight into the process that
medical device manufacturers, Medicare providers and the FDA have undertaken in
order to ensure that medical devices and equipment will be Y2K compliant. And,
to the extent that more work needs to be done, we must ensure that work is com-
pleted before the new year. The health and safety of Medicare patients is of the ut-
most importance.

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I would like to welcome all of our panels here today. Thank you all for coming
and testifying before us today.

PREPARED STATEMENT OF HON. GENE GREEN, A REPRESENTATIVE IN CONGRESS FROM


THE STATE OF TEXAS

Thank you Mr. Chairmen for scheduling todays important hearing.


I am very concerned that health care consumers of all ages will be adversely ef-
fected by computer glitches caused by Y2K.
To date, there has been a great deal of confusion and uncertainty about the Y2K
readiness of just about every public and private sector.
However, some things have a more pressing need to be fixed because of our reli-
ance on them for survival.
I believe medical devices are as critical to protect against Y2K failure as anything
else.
In todays technology-driven health care era, our reliance on complex and com-
puter driven medical devices has never been greater.
Americans of all ages rely on these devices to not only maintain their health, but
to keep them or their loved ones alive.
This is not the first hearing that we have had on this subject, and I would like
to commend those who have cooperated with our efforts on this matter.
I look forward to hearing from our witnesses today to learn more about the Y2K
readiness of medical devices and also to hear what work is left to be done on this
critical issue.
The time for action is now, so that we can ensure the safety of all Americans.
Mr. UPTON. Our first panel today includes the following individ-
uals. If you could come to the witness table. Dr. Thomas Shope,
Special Assistant to the Director, the Office of Science and Tech-
nology, Center for Devices and Radiological Health, from FDA. Mr.
William Hubbard, Senior Associate Commissioner for Policy, Plan-
ning and Legislation, again from U.S. FDA. Mr. Joel Willemssen,
Director of the Civil Agencies Information Systems, from the GAO.
And Mr. George Grob, Deputy Inspector General, Department of
HHS.
As you gentlemen know, as some of you have testified before, the
Oversight and Investigations Subcommittee always by practice has
taken testimony under oath. Do you have any objection to that?
[Witnesses respond in the negative.]
Mr. UPTON. And under House and committee rules, you are enti-
tled to have counsel. Do any of you require or need counsel this
morning?
[Witnesses respond in the negative.]
Mr. UPTON. If you would stand and raise your right hand. Do you
swear to tell the truth, the whole truth and nothing but the truth,
so help you God?
[Witnesses respond in the affirmative.]
Mr. UPTON. You are now under oath. And as you know, your tes-
timony will be made part of the record in its entirety. If you could
limit your remarks to 5 minutes, it would be terrific.
Dr. Shope, we will start with you. Thank you very much.
Mr. SHOPE. I dont have any opening remarks. Mr. Hubbard is
going to deliver those for FDA, and I will be here to help respond
to questions.
Mr. UPTON. Terrific. Mr. Hubbard.

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TESTIMONY OF WILLIAM K. HUBBARD, SENIOR ASSOCIATE
COMMISSIONER FOR POLICY, PLANNING AND LEGISLATION,
ACCOMPANIED BY THOMAS SHOPE, SPECIAL ASSISTANT TO
THE DIRECTOR, OFFICE OF SCIENCE AND TECHNOLOGY,
U.S. FOOD AND DRUG ADMINISTRATION; JOEL C.
WILLEMSSEN, DIRECTOR, CIVIL AGENCIES INFORMATION
SYSTEMS, ACCOUNTING AND MANAGEMENT DIVISION, GEN-
ERAL ACCOUNTING OFFICE; AND GEORGE GROB, DEPUTY
INSPECTOR GENERAL, DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Mr. HUBBARD. Thank you, Mr. Chairman. And we of course have
a written statement for the record, Mr. Chairman. So I will just
summarize some of the points.
When we were last here, the committee had concerns about med-
ical device failures, and concerns about drug availability. And al-
though you are not focusing on that today, I would like to mention
it briefly.
But let me update you on what we have done since we were last
here. For medical devices, as we testified last spring, we have iden-
tified those manufacturers of devices that are potentially high risk
if a Y2K failure should occur. That turned out to be just over 300
manufacturers who make about 90 different types of computer-con-
trolled devices. We then launched an intensive audit initiative to
sample 80 of those 300 manufacturers, about 25 percent, to deter-
mine if there were any problems, and as I said that was a random
sample, with the intent that if we found problems in those 80, we
would do more.
And I am pleased today to tell you that none of those audits
raised any significant concerns about failures of manufacturers to
properly address computerization of their devices. So we do believe
that the industry has done what it needs to do in this area, and
that while we cant claim success until after January 1, we are
very, very optimistic that things are moving very well.
For drugs and medical supplies, things like tubing and blood
bags and those sorts of things, we surveyed the industry to ask if
their manufacturing processes were Y2K compliant. This was done
both to gather safety information but also to be able to say to the
public that they dont need to worry when they get their prescrip-
tions filled at the end of December or January 1, that those drugs
and other products will be in stores.
We have followed that survey with comprehensive audits of a list
of the priority manufacturers, the people that are the sole source
manufacturers of a drug or hospital supply, orphan drugs, and the
makers of the top selling 200 prescribed drugs. And again, I am
pleased to inform you today that the vast majority, over 95 percent
of these priority manufacturers, are Y2K compliant, and that none
of those manufacturers, we believe, will experience problems that
will deprive patients of critically needed drugs and hospital sup-
plies.
In addition, we have done quite a bit in the way of outreach. One
of the important things is to get the word to hospitals that there
is a way to get information about these devices, to know whether
they are compliant or not, and if they are not compliant, how to
get the fix they need. So we and the Health Care Financing Admin-

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istration and the industry and others have attempted to reach out
intensively to the hospitals to let them know that.
We have also done various public announcements and have other
things in the works to tell the public they dont need to worry
about these products and do things like over-purchase and that
sort of thing. We have a toll-free number, a web site, brochures,
and I believe the committee has been given a consumer article, a
major article about how we are doing this, and why consumers can
be reassured. We also have an emergency operations center going
up at FDA which we will staff 24 hours a day, so that if any evi-
dence comes to us in late December or early January that there is
a problem, investigators, engineers and other scientists can rush
into that problem and make sure it gets fixed promptly.
I would like to close with the comment that I think the real
praise here is deserved by the industry, that the device and drug
manufacturers have done what they needed to do, invested the re-
sources and otherwise made sure that these products are not going
to be a problem, by and large. There may be a few isolated in-
stances which we will attempt to track down.
And in fact, we are still looking and asking hospitals and others
to tell us if they find a medical device that may fail that we did
not know about. Dr. Shope is constantly hearing stories or rumors
and trying to track those down. So far, we have not found them
and we are glad of that.
So with that, Mr. Chairman, I will be glad to take questions.
[The prepared statement of William K. Hubbard follows:]
PREPARED STATEMENT OF WILLIAM K. HUBBARD, SENIOR ASSOCIATE COMMISSIONER
FOR POLICY, PLANNING AND LEGISLATION, FOOD AND DRUG ADMINISTRATION

INTRODUCTION

Good morning, my name is William K. Hubbard. I am the Senior Associate Com-


missioner for Policy, Planning and Legislation, Food and Drug Administration (FDA
or the Agency). I am pleased to be here today to provide an update on the Year 2000
(Y2K) date issue as it relates to medical devices, drugs and biologics. In May of this
year, I appeared before the Committee and discussed with you the need for FDA
to allay the fears of the American public whether life-sustaining medical devices will
function as intended and whether there will be a sufficient supply of high priority
pharmaceuticals due Y2K issues. At that time, I told you that we were optimistic
that the industries were taking the necessary steps to guard against Y2K break-
downs. Now that it is October and the year 2000 draws near, I am here today to
tell you about FDAs efforts to validate our optimism.
FDA stepped up its efforts to gather more information on the Y2K readiness from
industry through additional surveys and audits. This additional data provides FDA
with a high degree of confidence in assuring the health care community and the
American public that essential medical supplies will be available; and medical de-
vices will function as intended; and that there will be a safe and adequate supply
of drugs available. The Agencys efforts to obtain additional data and the high de-
gree of confidence we have today is a tribute to the collaborative efforts among the
Federal sector, healthcare community and industry. Let me summarize for you the
Agencys efforts.
Y2K STATUS OF BIOMEDICAL DEVICES

FDA has taken a number of steps to enhance the confidence of the American pub-
lic that medical devices will function as intended as the year 2000 approaches. For
the past two years, FDA has continued to add to its knowledge of the Y2K status
of medical devices and to make this information available to healthcare facilities.
In developing this high level of confidence FDA has taken a number of constructive
actions to work with manufacturers and provide information to users about the Y2K
compliance of medical devices.

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FDAS Y2K DATABASE

An important tool for obtaining information about biomedical equipment is FDAs


Federal Year 2000 Biomedical Equipment Clearinghouse database. It is available
via the World Wide Web at www.fda.gov. While the database has proven to be use-
ful to healthcare facilities, professionals and consumersreceiving over 236,691
hits from 197,461 users over a period of 17 monthsFDA has continued to collect
information from medical device manufacturers. FDA believes that approximately
2,300 of the 16,000 biomedical equipment manufacturers could produce equipment
that could be affected by the Y2K problem. The vast majority of these 2,300 manu-
facturers have responded to FDAs requests for Y2K status information, and every
effort is being made to locate the remaining companies .
SURVEYS AND ASSESSMENTS

To bolster public confidence in industrys efforts to identify and resolve Y2K prob-
lems and to assure a continued supply of needed pharmaceuticals, biologics and es-
sential medical supplies, FDA conducted a voluntary survey of manufacturers of
drugs, biologics and consumable medical devices for Y2K readiness. These surveys
assessed manufacturers preparations and plans to continue operations after Janu-
ary 1, 2000. FDA then audited the survey results for a sample of the firms, as well
as a high proportion of high priority firms to confirm the survey reports. These sur-
veys indicate that the regulated industries have devoted considerable efforts to Y2K
preparations and we do not expect significant interruptions of necessary supplies.
POTENTIALLY HIGH RISK DEVICES (PHRDS)

Although FDA firmly believes that its normal regulatory processes provide the
necessary assurances that Y2K problems with high-risk devices will be carefully ad-
dressed, FDA implemented a plan to provide additional assurance to the public and
healthcare facilities about the Y2K status of medical devices. FDA addressed con-
cerns about the adequacy of the medical device industrys actions taken to avoid se-
rious Y2K problems by independently validating their Y2K self-assessments.
FDA developed and posted on the FDA Y2K website a list of types of potentially
high risk devices (PHRDs) that are likely to be computer-controlled and that could
present a significant risk of immediate harm to the patient should the devices fail
to operate as expected due to a Y2K problem. The PHRDs list contains 90 types of
potentially high-risk devices for which FDA has identified 803 PHRDs manufactur-
ers. An FDA contractor contacted these 803 firms and learned that approximately
60 percent have no computerized devices.
FDA initiated a special study designated as a Special Year 2000 Data Gathering
Request to examine the Y2K programs of a random sample of potentially high-risk
device (PHRD) manufacturers. Eighty of the PHRDs manufacturers were randomly
selected for an on-site assessment by an FDA contractor with extensive experience
in information technology and Y2K verification and validation. The study was de-
signed to:
provide a high level of assurance that manufacturers have properly assessed the
Y2K status of their computer-controlled medical devices;
examine manufacturers processes to evaluate how they assess the Y2K status of
their products;
verify that the manufacturers have developed and properly validated appropriate
upgrades to correct any Y2K problems for these devices; and,
confirm the information provided by manufacturers for the Federal Year 2000 Bio-
medical Equipment Clearinghouse database by examining the supporting docu-
mentation of the manufacturers.
RESULTS OF PHRDS ASSESSMENTS

As of October 15, 1999, the contractor has completed all 80 on-site reviews of
records to assess the existence and adequacy of manufacturers processes and proce-
dures implemented under a quality system. The assessments are intended to assure
that potentially vulnerable devices have been adequately assessed and that up-
grades are correctly implemented and appropriately tested and evaluated by the
manufacturer. As part of this process, FDA is evaluating the reports as they are
completed and to date has found no serious problems related to Y2K. The contractor
will provide FDA with a final report of the assessments in early November. FDA
will review the contractors report and will issue a summary report in early Novem-
ber. FDA is confident that the evaluation of these manufacturers will demonstrate
the thoroughness with which manufacturers have assessed and provided informa-
tion and corrections for non-compliant products.

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Now that manufacturers should have completed their assessments of Y2K compli-
ance status and identified non-compliant devices, FDA will review this information
to identify any manufacturers of PHRDs for which information is not available, or
whose non-compliant products pose an actual significant risk to patient health. For
firms that have declined to voluntarily participate in the PHRDs assessments, if
these firms have not been inspected recently by FDA, the Agency will consider by
the middle of November whether an FDA inspection of the firm should be con-
ducted, based on the possible level of risk that the product may present. In these
situations, FDA will review the steps taken by the manufacturers to notify users
regarding any problems that might exist and to assure that appropriate corrections
are implemented.
In any case where the action by the manufacturer has been inadequate to assure
patient safety, FDA will use its statutory authorities to require corrections and pub-
licize the situations. FDA is prepared to take action which would include public
advisories to device users, suggestions to manufacturers regarding voluntary recalls,
mandatory recalls or seizure of the non-compliant devices in extreme risk situations.
FDA expects, however, that the situations where such actions will be required will
be rare as there are many incentives in addition to possible FDA regulatory action
which lead manufacturers to address any such potentially high risk situations be-
fore FDA regulatory action is needed.
PHARMACEUTICAL INDUSTRY AND Y2K COMPLIANCE

FDA also has been examining the intersection of Y2K risk mitigation and the
availability and quality of certain prescription drugs. In fact, government agencies
and organizations within the pharmaceutical industry supply system (including
manufacturers, distributors, pharmacies, hospitals, physicians, pharmacists, insur-
ers and others) have been working closely together to prepare for the year 2000 date
change and its potential impact on the supply of pharmaceuticals.
In an effort to obtain additional data on this issue, on April 21, 1999, the FDA
Commissioner, Dr. Jane E. Henney, sent a letter to the Presidents and CEOs of ap-
proximately 4,228 pharmaceutical manufacturers, which includes prescription, over-
the-counter, and bulk drug manufacturers; distributors-repackagers; and, medical
gas manufacturers. The letter requested their assistance in assuring FDA and the
American public that their firms have addressed the Y2K problem as it affects the
adequate supply of safe and effective drugs. Included with the letter was a Y2K
Assessment Survey concerning the status of actions pharmaceutical firms have
taken to address this issue and assess Y2K readiness within the pharmaceutical in-
dustry. The focus of this effort is on prescription products with emphasis on the pri-
ority firms (sole source, orphan and the top 200 prescribed products).
Survey of Pharmaceutical Manufacturers
As of October 8, 1999, 3,132 or 74.1 percent responded to the survey, including
1,053 of the 1,070 or 98 percent of the prescription drug manufacturers that were
surveyed. Of the approximately 274 priority manufacturers (160excluding subsidi-
aries) which includes sole source, orphan and top 200 prescribed, 270 or 99 percent
have responded. Of the firms that completed the survey, 95 percent state they will
be ready for Y2K by the end of October with both the foreign and domestic firms
having a similar pattern of Y2K readiness. Priority companies who indicated a later
date are being contacted to determine their Y2K readiness and to make sure they
are on track for meeting their goals. FDA is committed to maximizing the response
rate particularly from the 274 priority manufacturers.
Pharmaceutical Audits
Many have urged that FDA take additional actions beyond the survey program
that will provide independent assurance of the adequacy of manufacturers Y2K as-
sessments and any resulting Y2K corrections. As a result, FDA decided to have a
contractor, with extensive experience in information technology and Y2K verification
and validation, audit each of the 160 highest priority pharmaceutical firms, as well
as a random sampling of other drug manufacturers. The surveys, by the contractor
via telephone or on-site interview, were begun on July 19, 1999.
As of October 8, 1999, 88 percent of the assessments have been completed. It is
important to note that to date the audit results have confirmed the findings of the
survey. These results provide the basis for a clear message to reassure the American
public that prescription drugs will continue to be available.
FDA and the pharmaceutical industry will continue to monitor the Y2K status
and availability of pharmaceutical supplies. FDA has processes in place to address
product availability and has used these procedures to help get necessary products

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11
to patients. FDA will continue to work with the health professional community, in-
dustry and patient groups regarding Y2K readiness and product availability.
BIOLOGICS INDUSTRY AND Y2K COMPLIANCE

Another section of the pharmaceutical industry produces biological drugs as well


as vaccines and blood products. We took the same survey/audit approach with these
manufacturers as well.
Survey of Biologics Manufacturers for Y2K Manufacturing Processes
On June 30, 1999, a survey was mailed to 1,576 licensed biologics manufacturers
and registered blood establishments. Letters to the biologics trade organizations re-
questing their assistance in encouraging participation in the survey effort were sent
on June 30, 1999. Of the responses that have been received, 92 percent report that
they will be Y2K ready by the end of October.
As of October 15, 1999, we have received responses from 1,483 or 94 percent of
the firms. Highest priority has been placed on 110 priority firms, which include li-
censed manufacturers of vaccines, therapeutics, allergenic products, viral marker
test kits and major blood organizations. As of October 15, 1999, 101 or 90 percent
of the high priority firms have responded.
Biologics Audits
Telephone/site visit audits of these 110 high priority firms began in late August
and as of October 14, 1999, audits have been completed for 83 or 75 percent of the
high priority firms. To date, we have no reports of problems regarding firms that
have been audited. We also have begun audits of a random sample of the firms that
are not in the high priority group. As of October 14, 1999, we have completed audits
of 48 of these firms with no problems identified.
CONSUMABLE MEDICAL SUPPLY INDUSTRY AND Y2K COMPLIANCE

Survey of Manufacturers of Consumable Medical Supplies for Y2K Manufacturing


and Distribution Processes
On June 18, 1999, surveys were mailed to 3,070 consumable medical supplies
manufacturers (approximately 2,000 domestic, 1,000 foreign). The focus of the sur-
vey is on those manufacturers that produce essential medical devices that are used
and consumed on a recurring basis during the delivery of essential healthcare serv-
ices and whose availability is critical to the uninterrupted delivery of health care
and patient welfare. The survey requests information on mission critical automated
manufacturing and distribution systems rather than Y2K status information on spe-
cific products. A follow-up letter was sent to non-respondents on July 23, 1999. As
of October 14, 1999, 2,074 responses and/or returned mail have been received with
approximately 90 percent of the fully analyzed responses (1309) reporting Y2K read-
iness by October 31.
Consumable Medical Supplies Audits
For a sample of survey respondents, validation of survey responses by the con-
tractor via telephone or on-site interview is being conducted. Highest priority for
these assessments will be the 225 manufacturers that produce a device only manu-
factured by 3 or fewer firms, so called few sources devices, and the 57 manufactur-
ers that are the sole source for a supply (the 57 manufacturers are included in the
225). Of the 225 few sources firms, 197 have responded, and of the 57 sole source
firms, 48 have responded. Attention also will be focused on those manufacturers
with inconsistent responses. As of
October 14, 1999, approximately 58 percent of the assessments of the priority
firms have been completed with no serious problems reported. Eighty-nine percent
report that they will be Y2K ready by the end of November. It is important to note
that the initial audit results confirm the survey results. We will continue to follow-
up with those manufacturers that are not Y2K ready and whose supplies, if not
available, could have a significant impact on health care delivery.
RECENT AGENCY WIDE OUTREACH EFFORTS

The FDA website, including the Federal Y2K Biomedical Equipment Clearing-
house database, provides much of the information needed by healthcare providers
and consumers regarding Y2K and FDA-regulated products. For answers to ques-
tions that can not be found on the Y2K website, FDA recently established a Y2K
telephone hotline which can be reached by calling FDAs main information line toll-
free at 1-888-INFO-FDA or using the Y2K e-mail form on the FDA Y2K website.

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FDA also has developed an extensive outreach initiative that will provide video
and audio news releases, brochures and articles designed to address the concerns
of the consumer and the healthcare community regarding Y2K issues. Additional
FDA outreach efforts are noted in the Appendix.
CONCLUSION

In summary, Mr. Chairman, there is now extrinsic and objective evidence that
drug and device manufacturers have taken the necessary steps to ensure that their
products and production facilities are ready for Year 2000 conversion.
Indeed, I believe that manufacturers, wholesalers, and retailers of these products
should be commended for taking this issue seriously and for devoting the necessary
resources to protect their customers and, ultimately, patients from Y2K related fail-
ures. For those few firms that have not taken these steps, FDA will be vigilant in
following up on any reports.
FDA will continue to work with other Federal agencies, patient groups, healthcare
provider associations and industry to optimize data collection and information shar-
ing. Together we can provide the American public with the needed assurances that
manufacturers will be Y2K ready. We all share a common goal of having medical
devices that will function as intended and a safe and adequate drug supply avail-
able for the American public as we continue through the year-end transition.
Thank you for the opportunity to testify.

APPENDIX
LETTERS TO MEDICAL DEVICE INDUSTRY

1997
June 25, 1997, notice to all medical device manufacturers (8,322 domestic and
5,085 foreign) registered with FDAs Center for Devices and Radiological Health
(CDRH) indicating that they needed to address this issue and review both em-
bedded and non-embedded software products.
1998
January 21, 1998, letter which was sent by DHHS to approximately 16,000 med-
ical device and biomedical equipment manufacturers to ask them to voluntarily
provide information on the Year 2000 compliance status of their products.
June 29, 1998, targeted, follow-up letter to specific manufacturers of potentially
vulnerable computerized devices.
September 2, 1998, follow-up to the June 29, 1998, letter directed to the manufac-
turers of potentially computerized devices who had not responded to the pre-
vious requests.
August 14, 1998 and September 2, 1998, letters from Dr. Bruce Burlington, then
Director, CDRH, and Dr. Friedman, then Acting Commissioner of the Food and
Drug Administration, to the Health Industry Manufacturers Association
(HIMA) requesting that the Association take aggressive and immediate actions
to encourage and assist medical device equipment manufacturers in providing
information to FDA.
Late September 1998, FDA posted on the website those manufacturers of selected
product categories that are likely to include vulnerable products that had not
provided a response to FDAs inquiries.
1999
March 3, 1999, letter requesting that the 2,300 targeted biomedical equipment
manufacturers carefully review the Year 2000 status information that they have
provided or intended to submit, and, where necessary, provide more specific in-
formation on non-compliant products.
March 29, 1999, letter requesting that targeted medical device manufacturers
submit a complete list of individual product models that are Year 2000 compli-
ant. Responses from 572 manufacturers have been received as of June 1, 1999.
July 16, 1999, Public Health Notification regarding date-related computer con-
trolled medical devices to administrators, risk managers and biomedical/clinical
engineers of 67,000 hospitals and healthcare facilities. The notification urged
them to develop contingency and remediation plans to avoid serious adverse
events; provided information to assist them in contingency planning; provided
information about the Federal Y2K Biomedical Equipment Clearinghouse
website; and encouraged them to report problems or adverse events associated
with Y2K and computer-controlled devices to FDAs MedWatch Program.

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Additional Outreach and Guidance
In an effort to reach the widest group of individuals, both to get information and
to spread information, CDRH also has been conducting extensive outreach to the de-
vice industry and to other consumers on this issue. These efforts are as follows:
CDRHs Division of Small Manufacturers Assistance provided an article in May
1998 entitled Biomedical Equipment Manufacturers Urged to Share Year 2000
Information to 12 medical device trade press contacts and to 65 U.S. and 35
foreign medical device trade associations in order to facilitate the dissemination
of information to their members regarding the website database and to encour-
age the posting of data by manufacturers.
The website and database were mentioned in the FDA Column of the June 3,
1998, Journal of the American Medical Association and in an article in FDAs
Medical Bulletin that was sent to approximately 700,000 healthcare practi-
tioners this past summer.
In the spring of 1998, CDRH developed a Guidance Document on FDAs expecta-
tions of medical device manufacturers concerning the Year 2000 date problem.
The guidance is available on the FDA website.
FDA also developed an article addressed to the users of radiation treatment plan-
ning systems regarding the need to assess these systems. The article was pub-
lished in the newsletters of relevant professional associations.
Staff of CDRH have participated in numerous conferences and video telecon-
ferences devoted to the Year 2000 problem in healthcare in order to commu-
nicate with healthcare facilities regarding the Biomedical Equipment Clearing-
house and the need to address the Year 2000 issue with devices.
March 29, 1999, memorandum issued by the Director, Division of Emergency and
Investigational Operations, Office of Regulatory Affairs (ORA), to the FDA field
instructing investigators to expand the Year 2000 activities to include asking
questions regarding what the firm has done to assure that the computer con-
trolled and date-sensitive products, manufacturing processes and distribution
systems are Year 2000 compliant.
On May 17, 1999, the Presidents Council on Year 2000 Conversion in conjunction
with the Veterans Health Administration hosted a Roundtable event. The dis-
cussion focused on those services and supply chains that are critical to the
health and well-being of all Americans, and in particular the ready availability
of pharmaceuticals from their manufacture to the filling of prescriptions at the
drug store. The consensus of those present at the Roundtable (the brand name
and generic drug manufacturers, wholesalers, and health care providers, payers,
along with consumer advocates and government regulators) is that allowing pa-
tients to obtain a substantial advance (buying or stockpiling) is not necessary
and may actually cause the shortage that this kind of action is trying to pre-
vent. FDA continues to work with the pharmaceutical industry, associations,
and other Federal agencies to assure a safe and adequate pharmaceutical sup-
ply.
In a letter to providers, Health Care Financing Administration (HCFA) noted the
FDA website for providers to obtain information on medical devices and Y2K
compliance status information.
FDA has participated in 18 national and regional HCFA conferences and three
National Association of Rural Health Clinics regional conferences which in-
cluded discussions of FDAs Y2K activities, status of the Federal Y2K Bio-
medical Equipment Clearinghouse, pharmaceutical supply issues and future
Agency activities.
On April 16, 1999, a Guidance for Industry and the Clinical Community on Med-
ical Device Reporting for Date-Related Problems Including Y2K.
On June 7, 1999, FDA participated in a Presidents Council on Year 2000 Conver-
sion Roundtable event on medical supplies.
On August 18, 1999, FDA staff participated in a Health Resources and Services
Administration (HRSA) teleconference entitled Making Your Health Facility
Y2K Compliant directed to HRSA funded rural health clinics.
On August 24, 1999, FDA issued a Talk Paper entitled The Year 2000 Date Prob-
lem and Medical Devices.
Although most devices are regulated by CDRH, FDAs Center for Biologics Eval-
uation and Research (CBER) regulates blood bank software, which is of particular
concern for potential Year 2000 problems. In January 1998, CBER posted guidance
for industry entitled A Year 2000 Date Change for Computer Systems and Software
Applications Used in the Manufacture of Blood Products on the FDA website. The
guidance provided specific recommendations to assist industry in its evaluation of
computer and software systems used in the manufacture of blood products and to

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assist in evaluating the impact of potential Year 2000 problems. CBER is aware of
the status of these individual products and believes that the blood bank software
will be Y2K compliant or will have a patch or work-around for the systems to
ensure that the systems will work through Year 2000.
Mr. UPTON. Thank you.
Mr. Willemssen?

TESTIMONY OF JOEL C. WILLEMSSEN


Mr. WILLEMSSEN. Thank you, Mr. Chairman, Chairman Bili-
rakis, Ranking Member Brown, members of the subcommittees,
thank you for inviting GAO to testify today.
As requested, I will briefly summarize our statement. Over 4,000
manufacturers have submitted data to FDAs biomedical clearing-
house. And about 61 percent of them reported having products that
do not use a date, while about 8 percent or 342 manufacturers re-
ported having date related problems. According to FDA, these man-
ufacturers reported about 1,000 products with date-related prob-
lems.
FDA also accepts links to manufacturers web sites for compli-
ance information, rather than requiring individual submissions.
And 429 companies have provided these links. As we testified be-
fore you in May, FDA stated it did not know the total number of
products reported by these companies and how many had date-re-
lated problems.
We reviewed all of those web sites and identified a total of more
than 32,000 biomedical products, and we found that about 4,000
are considered non-compliant by the manufacturer. This is about
four times the total number of non-compliant products that manu-
facturers individually reported to FDA.
In addition, the quality of the compliance information on web
sites varied significantly ranging from general assurances of com-
pliance to detailed information on specific make and model. We be-
lieve it is critical to have that kind of detailed information and
therefore think FDA should request manufacturers to provide this
information on their web sites.
Let me next turn to FDAs review of biomedical manufacturers.
Last year, we recommended that HHS take steps to review manu-
facturers compliance test results for critical care and life support
biomedical equipment to give added assurance that such equipment
was compliant. At your hearing in May, FDA agreed that it would
compile a list of computer controlled potentially high risk devices
and develop a list of manufacturers of these devices and select a
sample of them for review.
FDA has now done that, and has identified 90 types of products
considered potentially high risk devices and 803 manufacturing
sites for these products. It should be noted that about 200 of those
sites are in other countries.
Our review of the first 25 site assessment reports that were
available to us showed that most of the assessments were identi-
fying a low level of concern and that until recently, no assessments
were showing a level of concern that would be considered a risk to
patient safety. However, earlier this week, FDA informed us that
a report had been submitted showing a high level of concern for
one site.

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Next, turning to health care providers, available data indicate


that most providers responding to surveys who have used the FDA
clearinghouse view it as helpful. However, many of the providers
who have responded to surveys stated that they have not used the
clearinghouse.
And finally, the question of whether to test biomedical equipment
for Y2K compliance is a difficult one that confronts many users
such as hospitals and physicians offices. In contrast to FDAs posi-
tion that manufacturers submissions of Y2K certifications provide
sufficient assurance of compliance, some hospitals believe that test-
ing of equipment is necessary to prove that they have exercised due
diligence in the protection of patient health and safety.
Our review of manufacturers web sites disclosed that manufac-
turers opinions on whether users should test equipment vary, with
many providing information on Y2K testing and others saying that
testing could disrupt the operation of software. We continue to be-
lieve that the overriding criterion in deciding whether to independ-
ently test is patient health and safety.
That concludes a summary of my statement, and I would be
pleased to address any questions.
[The prepared statement of Joel C. Willemssen follows:]
PREPARED STATEMENT OF JOEL C. WILLEMSSEN, DIRECTOR, CIVIL AGENCIES INFOR-
MATION SYSTEMS, ACCOUNTING AND INFORMATION MANAGEMENT DIVISION, GAO

Messrs. Chairmen and Members of the Subcommittees: Thank you for inviting us
to participate in todays hearing on the Year 2000 (Y2K) compliance status of bio-
medical equipment.1 The question of whether medical devices, such as magnetic res-
onance imaging (MRI) systems, x-ray machines, pacemakers, and cardiac monitoring
equipment, can be counted on to work reliably on and after January 1, 2000, con-
tinues to be one of critical importance to our nations health care. To the extent that
biomedical equipment uses computer chips, it is vulnerable to the Y2K problem.2 In
the medical arena, such vulnerability carries with it possible safety risks.
Responsibility for oversight and regulation of medical devices, including the im-
pact of the Y2K problem, lies with the Food and Drug Administration (FDA)an
agency within the Department of Health and Human Services (HHS). Since the fall
of 1998, FDA has been providing information collected from medical device and sci-
entific and research instrument manufacturers through its Federal Y2K Biomedical
Equipment Clearinghouse.3
My testimony today will discuss (1) the status of FDAs Federal Y2K Biomedical
Equipment Clearinghouse; (2) compliance status information on manufacturers web
sites referred to in FDAs clearinghouse; (3) FDAs efforts to review the Y2K activi-
ties of manufacturers of computer-controlled, potentially high-risk devices; (4) infor-
mation on the compliance status of health care providers biomedical equipment;
and (5) information on compliance testing of equipment.
BACKGROUND

Biomedical equipment is indispensable; it plays a central role in virtually all


health care. It is defined as any tool that can record, process, analyze, display, and/
or transmit medical datasome of which may include medical devices, such as pace-
makers, that are implanted in patientsand laboratory research instruments, such

1 Biomedical equipment refers both to medical devices regulated by FDA, and scientific and
research instruments, which are not subject to FDA regulation.
2 As is widely known by now, for the past several decades computer systems have often used
two digits to represent the year, such as 98 for 1998, in order to conserve electronic data stor-
age and reduce operating costs. In this format, however, 2000 is indistinguishable from 1900
because both are represented as 00. As a result, if not modified, systems or applications that
use dates or perform date- or time-sensitive calculations may generate incorrect results beyond
1999.
3 This site can be accessed on the Internet World Wide Web at http://www.fda.gov/cdrh/yr2000/
year2000.html.

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as gas chromatographs 4 and microscopes. Such equipment may use a computer for
calibration or for day-to-day operation. If any type of date or time calculation is per-
formed, susceptibility to a Y2K problem exists, whether the computer is a personal
computer that connects to the equipment remotely, or a microprocessor chip embed-
ded within the equipment itself. This could range from the more benignsuch as
incorrect formatting of a printout or incorrect display of the dateto the most seri-
ousincorrect operation of equipment with the potential to decrease patient safety.
The degree of risk depends on the role of the equipment in the patients care.
As part of its oversight and regulatory responsibility for domestic and imported
medical devices, FDA has been collecting Y2K compliance status information on
these devices, as well as on some scientific and research instruments. Its goal has
been to provide a comprehensive, centralized source of compliance information on
biomedical equipment used in the United States, and make this information publicly
available through an Internet World Wide Web site. In addition, the Veterans
Health Administration (VHA)a key federal health care provider 5took a leader-
ship role in determining the Y2K compliance status of biomedical equipment. Spe-
cifically, it obtained information from manufacturers on the compliance status of
biomedical equipment in its inventory, and shared this information with FDA.
FDA has also acted to identify products within the array of medical devices used
in health care where Y2K problems could pose a risk to patient health and safety.
It identified 90 types of products that it refers to as computer-controlled, potentially
high-risk devices (PHRD).6 These medical devices are characterized by their poten-
tial for immediate and serious adverse health consequences for a patient if they fail
to function as designed or expected, including a failure to initiate or continue oper-
ation. These devices are
used in the direct treatment or therapy of a patient, the failure of which could
result in patient injury or failure of an intended treatment;
used in the monitoring of vital patient parameters, information that is needed im-
mediately for effective treatment; or
necessary to support or sustain life during treatment or patient care.
PHRD products identified by FDA include breathing frequency monitors,
electroanesthesia apparatus, hemodialysis systems and accessories, and fetal ultra-
sonic monitors and accessories.7 Also included on the list of PHRD products is
equipment used to collect human blood and manufacture blood products.8
BIOMEDICAL EQUIPMENT STATUS INFORMATION AVAILABLE THROUGH FDA
CLEARINGHOUSE

HHS, on FDAs behalf, initiated action to collect biomedical equipment informa-


tion in January 1998 by issuing a letter to domestic and foreign manufacturers re-
questing information on the Y2K compliance of their product lines. All information
received from these manufacturers was then to be made available to the public
through an FDA web site.
As we reported in September 1998, FDAs database did not include product com-
pliance information from many manufacturers that had already provided such infor-
mation to VHA; 9 further, VHA was not making this information available to the
public. We therefore recommended that HHS and VHA jointly develop a single data
clearinghouse containing information on the Y2K compliance status of biomedical
equipment, and make this information publicly available.10 In response to our rec-
ommendation, FDAin conjunction with VHAestablished the Federal Y2K Bio-
medical Equipment Clearinghouse.
VHA, the Department of Defense, and the Health Industry Manufacturers Asso-
ciation all assisted FDA in obtaining compliance status information from manufac-
turers. According to FDA, 4,288 biomedical equipment manufacturers had submitted
data to the clearinghouse as of October 4, 1999.

4 Such instruments are used to separate the components of a solution with heat and measure
their relative quantities.
5 A component of the Department of Veterans Affairs (VA).
6 Appendix I lists the 90 PHRD product types.
7 An electroanesthesia apparatus uses electricity to induce and maintain anesthesia during
surgical procedures. Hemodialysis systems cycle blood from a patients body to filter out body
waste before returning the blood to the patient. Fetal ultrasonic monitors use sound to measure
the heart rate of the fetus and uterine contractions of the mother during pregnancy and child-
birth.
8 Examples of such equipment include automated blood cell and plasma separators for thera-
peutic purposes and instruments used to screen the blood supply for blood-borne pathogens.
9 Year 2000 Computing Crisis: Compliance Status of Many Biomedical Equipment Items Still
Unknown (GAO/AIMD-98-240, September 18, 1998).
10 GAO/AIMD-98-240, September 18, 1998.

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17
Based on the data submitted, FDA places a manufacturer into one of four cat-
egories:
Products that do not employ a datemanufacturer reported status as All Prod-
ucts Do Not Use a Date.
Products that are all compliantmanufacturer reported all products Y2K compli-
ant.
Products with date-related problemsmanufacturer reported status as Products
With Date-Related Problem.
Product status on manufacturers web pagemanufacturer reported status to be
Product Status Specified on a (Web) Page.
As shown in figure 1, as of October 4, 1999, 61 percent of the manufacturers re-
ported having products that do not employ a date, while 8 percent (342 manufactur-
ers) reported having date-related problems such as incorrect display of date/time.
According to FDA, the 342 manufacturers reported 1,035 specific products with
date-related problems. Compliance data for 429 manufacturers were reported on
their web sites and linked through the FDA clearinghouse.

Figure 1: Biomedical Equipment Compliance-Status Information Reported to FDA


by Manufacturers as of October 4, 1999.

Note: Total number of manufacturers = 4,288.


Source: FDA.
This total (4,288) excludes 132 manufacturers who, according to FDA, had not re-
sponded to the agencys request for product compliance information as of October
4, 1999. According to a top official in FDAs Center for Devices and Radiological
Health, most of these manufacturers have gone out of business, do not make com-
puterized products, or just cannot be located. This official added that FDA neverthe-
less continues to follow up with these manufacturers through letters and telephone
contact. The clearinghouse lists the names of these manufacturers who have not re-
sponded to FDAs requests for product compliance information.
Our September 1998 report also noted that information on the FDA web site was
not detailed enough to be useful.11 Specifically, the list of compliant equipment con-
tained no information on equipment make or model. We therefore recommended
that VA and HHS include in the clearinghouse information on the compliance status
of all biomedical equipment by make and model. FDA agreed, subsequently request-
ing this information from manufacturers; users can now find specific information on
the make and model of compliant medical devices on-line.

11 GAO/AIMD-98-240, September 18, 1998.

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18
QUALITY OF COMPLIANCE INFORMATION ON MANUFACTURERS WEB SITES VARIES
SIGNIFICANTLY

As an alternative to obtaining biomedical equipment product compliance informa-


tion from manufacturers and posting it to the Federal Y2K Biomedical Equipment
Clearinghouse, FDA accepts equipment manufacturers references to their own web
sites for compliance information. The clearinghouse provides users with a direct link
to these web sites. As of October 1, 429 manufacturers had chosen this option, link-
ing their web sites through the clearinghouse.
While FDA is aware of the number of products and their reported compliance sta-
tus for those manufacturers providing this information to the clearinghouse, in testi-
mony before these Subcommittees this past May, officials stated that they did not
know the total number of biomedical equipment products reported by manufacturers
on their web sites, or how many of them were noncompliant. We subsequently re-
viewed information available through these web sites and reported in June that the
quality of information available through them varied significantly.12 Specifically,
while most sites contained compliance information on at least one product, some
contained insufficient information or did not clearly distinguish biomedical equip-
ment from nonbiomedical products.
Because of the Subcommittees interest in the compliance information on the man-
ufacturers web sites, we reviewed this information to identify the total number of
biomedical equipment products reported, and categorized their compliance status.13
We also reviewed these sites to assess the clarity and completeness of the informa-
tion reported.
As of October 1, 1999, FDAs clearinghouse listed 429 manufacturers referring
users to their web sites. Of this total,
354 manufacturers reported compliance status information for at least 32,598 in-
dividual biomedical equipment products; 14
71 manufacturers web sites either contained insufficient information on the num-
ber of products and their compliance status, or did not clearly distinguish bio-
medical equipment from nonbiomedical products;
3 web sites were those of vendors or distributors, not manufacturers; and
1 manufacturers web-site link in FDAs clearinghouse did not work.15
Because of the limitations cited above for many of the manufacturers web sites,
our ability to determine the total number of biomedical equipment products reported
and their compliance status was impaired. Accordingly, the actual number of prod-
ucts reported by these manufacturers could be higher than the 32,598 that we
counted.
As shown in figure 2, of the 32,598 products that we were able to identify on man-
ufacturers web sites, about 54 percent reportedly do not employ a date, about 29
percent of the products are considered compliant, and about 12 percent are report-
edly noncompliant. The compliance status of the remaining 5 percent of products
was unknown, for reasons such as the manufacturers ongoing assessment of the
product.

12 Year 2000 Computing Challenge: Concerns About Compliance Information on Biomedical


Equipment (GAO/T-AIMD-99-209, June 10, 1999).
13 We summarized the results of our review in four compliance categoriesproducts that do
not employ a date, products that are compliant, products that are noncompliant, and products
whose compliance status is currently unknown. This last category includes those manufacturers
who reported that they have not completed an assessment of their products, have discontinued
a product, or have a product that is now obsolete.
14 This includes medical devices, scientific and research instruments, and other supporting
products, such as printers and software.
15 According to FDA, the contractor assisting it with the clearinghouse verified that this web
site link was operable.

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19
Figure 2: Biomedical Equipment Compliance-Status Information Reported on
Manufacturers Web Sites as of October 1, 1999.

Note: Total number of products = 32,598.


Source: GAO analysis of manufacturers web sites.
The 4,053 noncompliant products that we identified were from the web sites of
214 manufacturers. This number of noncompliant products is about four times the
number reported directly by FDA in its clearinghouse (1,035). Examples of these
noncompliant products included a bedside monitor, film digitizer, ultrasound sys-
tems, radiology information systems, and laboratory information systems. Included
among noncompliant PHRDs were ventricular assist devices and hemodialysis
equipment.16
In addition to supplying information on noncompliant products, most of the manu-
facturers with noncompliant products also provided solutions for correcting the prob-
lem. At least one solution to correcting a problem was offered by 190 of the 214
manufacturers we identified with noncompliant products. The solutions generally in-
volved upgrades to hardware or software, manual action (such as turning the equip-
ment on and off on January 1, 2000), or workarounds.17 We also noted that for these
190 manufacturers, at least 29 offered Y2K solutions to all their products at no
charge, 9 offered no-charge solutions for more that 50 percent of their product line,
13 offered no-charge solutions to less than 50 percent of their product line, and 12
offered no solutions free of charge. For the remaining 127 of the 190 manufacturers,
we were unable to determine if Y2K solutions were available to users free of charge.
Our review disclosed that the quality of the information on manufacturers web
sites continued to vary significantly. It ranged from general assurances of compli-
ance to detailed information on specific product make and model. For example:
A manufacturer reported that its products had no Y2K issues, but it did not iden-
tify the products.
A manufacturer reported that it was still assessing its products, and did not pro-
vide any detailed information on its web site.
A manufacturer did not list theY2K readiness of products but did report that the
only Y2K problem it was having was with the software it used to run its busi-
ness.
A manufacturer listed about 65,000 products, but did not sort them by type so
that the biomedical products could be easily identified.

16 A ventricular assist device is a small electromechanical pump that helps maintain blood cir-

culation in patients suffering from end-stage heart disease. Hemodialysis equipment cycles blood
from a patients body to filter out body waste before returning the blood to the patient.
17 An example of a workaround is noting on the printout of an EKG machine the year 2000

instead of 1900.

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20
A manufacturer reported that for its 282 products, 79 were compliant, 50 were
noncompliant, the status of 43 was currently unknown, and 110 were not af-
fected by the Y2K problem. It also provided solutions for its reported noncompli-
ant products.
A manufacturer reported compliance information for 97 products, by make and
model. Of these, 72 were compliant, 17 were noncompliant, 1 product was cur-
rently under assessment, and Y2K did not apply to 7 products. It also provided
solutions for various noncompliant products, including information on the avail-
ability of solutions and whether to replace the noncompliant product.
Because both the quality of and access to compliance information are critical to
biomedical equipment users, any problems with information on manufacturers web
sites could have a direct bearing on the ability of health care providers to identify
and correct any noncompliant equipment in their inventories. Accordingly, we be-
lieve that FDA should request that manufacturers that are providing information
through their web sites clearly identify product make and model, compliance status,
and availability of solutions for noncompliant equipment.
FDA IS NOW REVIEWING MANUFACTURERS Y2K ACTIVITIES

While compliance information is available through FDAs Federal Y2K Biomedical


Equipment Clearinghouse, we have raised concerns in the past year about the lack
of independent verification and validation of biomedical equipment that manufactur-
ers have certified as compliant. In addition to making sure that manufacturers pro-
vide detailed information on their products, we believe that it is essential that FDA
provide some level of confidence that critical care and life support medical devices
will work as intended.
In response to our previously reported concerns, FDA is now reviewing a sample
of biomedical equipment manufacturers Y2K activities, such as risk management,
test planning and procedures, and implementation and contingency planning. In
September 1998, we first reported that FDA did not require manufacturers to sub-
mit test results certifying product compliance.18 Rather, we noted, FDA relies on the
manufacturer to validate, test, and certify that it has adequately addressed any Y2K
problem. As a result, we stated that FDA lacked assurance that biomedical equip-
ment manufacturers had adequately addressed the Y2K problem for noncompliant
equipment.
Accordingly, we recommended that HHS take prudent steps to review manufac-
turers compliance test results for critical care/life support biomedical equipment, es-
pecially equipment once determined to be noncompliant but now deemed compliant,
and that for which concerns about the determination of compliance remain. At the
time, HHS and FDA did not concur with our recommendation. They reasoned that
submissions of appropriate certifications were sufficient, further stating that they
did not have the resources to undertake such reviews.
As mentioned, HHS and FDA have now changed this position. In a May 25, 1999,
hearing before these Subcommittees, FDAs Acting Deputy Commissioner for Policy
testified that FDA proposed reviewing manufacturers test results supporting com-
pliance certifications for a sample of critical devices. FDAs proposal consisted of two
phases. In the first phase FDA would
develop a list of the manufacturers of these devices;
from this list of manufacturers, select a sample of 80 for review; and
hire a contractor to develop a program to assess manufacturers activities to iden-
tify and correct Y2K problems with PHRDs.
The goal of the first phase of the survey is to extrapolate from the 80 assessments
a level of overall confidence in the biomedical equipment industrys Y2K compliance
activities. According to FDA, the second phase of the evaluation would be under-
taken only if the results of the first phase indicated a need for further review of
manufacturer Y2K activities because of concerns about how manufacturers are ad-
dressing the issue of product compliance.
In carrying out its plan to assess manufacturers Y2K activities, FDA issued a
task order on July 1, 1999, for a contractor, assisted by two subcontractors, to per-
form assessments of the Y2K compliance activities for a sample of PHRD manufac-
turers. FDA identified 803 PHRD manufacturing sites that produce equipment sold
in the United States.19 These were comprised of 726 biomedical equipment manufac-

18 GAO/AIMD-98-240, September 18, 1998.


19 The 803 consisted of those manufacturers among the 90 types of PHRDs identified that had
registered PHRD products with FDA.

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21
turing sites and 77 manufacturing sites of blood and blood products equipment
which manufacture product types listed in appendix I.
FDAs contractor then randomly selected 325 of the 803 sites for possible assess-
ment. These manufacturing sites were then contacted and asked if they would vol-
unteer to participate in the assessment process. As of October 4, 1999, of the 325
randomly selected sites,
197 were identified as producing no computer-controlled equipment,
80 agreed to participate,
26 declined to participate, 20
18 were duplicates, 21 and
4 did not respond.
To carry out the on-site assessments of manufacturing sites, the contractor devel-
oped a guide for its examiners. This guide focused on the firms Y2K activities in
six areas: (1) executive leadership and control, (2) risk management, (3) corrective
and preventive actions, (4) test planning and procedures, (5) communication with
the consignee (user of the products), and (6) implementation and contingency plan-
ning.
After completing these assessments at the manufacturers sites, examiners were
required to prepare a report of concerns in each of the six areas reviewed. Concerns
were identified as high, medium, or low, as defined below:
highactions that are not timely, inadequate planning, inadequate or incomplete
resources, incomplete or inaccurate deliverables, inability to validate results,
and/or inadequate due diligence;
mediumactions that are somewhat late, incomplete planning, insufficient or in-
complete resources, deficiencies in deliverables, and/or incomplete validation of
results; and
lowactions that are on schedule and have adequate resources.
According to FDAs PHRD survey project manager, as of October 15, 1999, exam-
iners had completed all 80 manufacturer site assessment visits, and had prepared
62 assessment reports.
We reviewed the 25 manufacturer site visit reports that were completed by the
examiners and available to us as of September 10, 1999. For 20 of these assess-
ments, the examiners assessed concern was low. At the five remaining manufac-
turing sites, the examiner found at least one item of moderate concern in the six
areas, such as test planning and procedures. According to the PHRD survey project
manager, the areas identified in the site visit reports as medium risk do not con-
stitute a risk to patient health or safety.
Until recently, none of the site visit reports submitted to FDA contained a concern
assessed as high. However, earlier this week, the PHRD survey project manager in-
formed us that FDA had just received a site visit report with concerns assessed as
high in two areasleadership and control, and test planning and procedures. The
report stated that the manufacturers policies and procedures were found to be in-
consistent, ambiguous, and were not followed in a manner that would meet due dili-
gence requirements. It also noted that the qualifications of the manufacturers per-
sonnel for specified tasks were not well defined, and that some personnel assigned
to tasks identified in the policies and procedures were not qualified to perform those
tasks. The report concluded that the manufacturers procedures for Y2K assessment
and corrective and preventive action were less than adequate, and that assessment
procedures had not been applied consistently. The manufacturer subsequently told
the examiner that action would be taken on the issues raised. FDA officials told us
that they plan to follow up with the manufacturer.
The project manager also told us that FDAs contractor is in the process of pre-
paring a final report summarizing the overall findings from the 80 site visit assess-
ment reports, detailing any problems encountered during the project. This indi-
vidual indicated that FDA expects to receive the final report from the contractor
later this month. Although FDA initially expected to submit a final report to HHS
by October 1, it has not yet established a date for when this will occur.
To assess how the contractor was executing FDAs task order, we observed se-
lected site assessments. At the five manufacturing site assessments we observed, ex-
aminers generally followed the contractor-developed audit guide and were knowl-
edgeable about information technology management, Y2K testing, and risk assess-

20 According to FDA, reasons given by manufacturers for declining to participate included


scheduling or resource limitations, and recent regular FDA site inspections. Five manufacturing
sites declined without giving a reason.
21 These sites involved large, multi-site manufacturers where the FDA contractor had already
selected two or more of the same manufacturers sites. According to FDA, the contractor did not
assess duplicates if they came up in later samples.

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22
ment. During our two initial visits, we noted that examiners sometimes could not
answer questions from the manufacturers relating to the FDA clearinghouse and
the processing of the final report on the site assessments. We subsequently shared
these observations with FDA officials. FDA agreed to consider our suggestions, such
as better communicating to the firms the final reporting process and how the FDA
Federal Y2K Biomedical Equipment Clearinghouse works. During the later three
visits, we did not observe any similar areas of concern.
Many of the 803 PHRD manufacturing sites identified by FDA are in foreign loca-
tions. Specifically, our review of the 803 sites on FDAs list showed that 203 were
located in 27 foreign countries (appendix II lists these countries). Of the 325 ran-
domly selected for assessment, 233 were in the United States and 92 were in 22
foreign countries. Finally, of the 80 locations where manufacturers agreed to be as-
sessed by FDA, 65 are located in the United States and 15 are located in 8 other
countriesCanada (1 site), Finland (2), Germany (4), the Netherlands (1), Norway
(1), Sweden (2), Switzerland (1), and the United Kingdom (3).
INFORMATION ON BIOMEDICAL EQUIPMENT COMPLIANCE OF HEALTH CARE PROVIDERS
INCOMPLETE

While information is available on the Y2K compliance status of biomedical equip-


ment through the FDA clearinghouse and other sources, it is not clear at this time
how extensively health care providers are using this information to determine their
Y2K readiness. According to FDA, it has taken steps to make users aware of the
clearinghouse. For example, FDA has published articles in professional trade jour-
nals and participated in conferences aimed at health care facilities.
FDA also informed us that the Federal Y2K Biomedical Equipment Clearinghouse
had received about 317,000 inquiries between April 1998 and September 1999. How-
ever, according to FDA, it is not possible to determine the sources of the inquiries.
To determine whether health care providers were using the FDA clearinghouse
to assess the Y2K compliance status of their biomedical equipment, we reviewed
readiness surveys sent to providers by several federal agencies and professional
health care associations.22 For example, the American Medical Association (AMA)
surveyed a random sample of 7000 of its members in July/August 1999 on whether
they were aware of the FDA clearinghouse; only 17 percent of respondents indicated
that they were.
In addition, a July 1999 HHS Office of Inspector General (OIG) survey sent to
hospitals, nursing facilities, home health agencies, and physicians contained three
questions on FDAs clearinghouse. These questions related to awareness, usage, and
whether the clearinghouse was helpful.
Responses to the HHS OIG survey varied significantly. For example, about 80
percent of the hospitals responding stated that they were aware of the clearing-
house, but less than half of the nursing facilities, home health agencies, and physi-
cians responding stated this same awareness. Further, while about 60 percent of the
responding hospitals reported that they used the clearinghouse, 25 percent or fewer
of the responding nursing facilities, home health agencies, and physicians reported
using the clearinghouse to obtain readiness information about their biomedical
equipment.
The HHS OIG survey noted that there was general agreement among the re-
spondents that the clearinghouse information was helpful. Specifically, 100 percent
of the physicians, 95 percent of the nursing facilities, 91 percent of the hospitals,
and 87 percent of the home health agencies that said they had used clearinghouse
data said they found the information to be helpful.
Although compliance information on biomedical equipment is available through
FDAs clearinghouse, theY2K readiness status of equipment at health care pro-
viders offices is not known because a significant number of providers did not re-
spond to the surveys. As shown in table 1, the response rates to the July survey
from the HHS OIG to nursing facilities, home health agencies, and physicians were
all less than 50 percent. The response rates to surveys from AHA and AMA on this
subject were even less, at 29 and 8 percent, respectively. Lastly, the response rate
to a survey from the American Health Care Association (AHCA) 23 was even more
disappointing, at less than 3 percent.

22 These include HHS Office of the Inspector General, American Hospital Association (AHA),
and AMA.
23 This is a federation of 50 state health organizations that represent nearly 12,000 nonprofit
and for-profit assisted living, nursing facility, long-term care, and subacute-care providers.

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23
Table 1: Reported Survey Results of Y2K Readiness of Biomedical Equipment
Percentage Percentage
Number Number of Responding
Entity Performing Survey/Group Surveyed Responding
Surveyed Responses Currently Dont Know
Compliant

HHS Office of the Inspector General (July 1999)


HOSPITALS ...................................................................................... 1000 1 53 27 5
NURSING FACILITIES ....................................................................... 1000 1 230 50 25
HOME HEALTH AGENCIES ............................................................... 1000 1 159 48 27
PHYSICIANS .................................................................................... 1000 1 79 56 22
American Hospital Association (AHA) (February 1999) 2,000 583 6 2
American Medical Association (AMA) (July/August 1999) ............. 7,000 544 3 4

American Health Care Association (AHCA) (March 1999) ............ 12,000 5 342 24 4

American Medical Group Association (AMGA) 2 (March 1999) ...... 230 99 42 4

Source: Organizations listed. We did not independently verify this information.


1 The number of respondents who selected not applicable for the question were excluded from the number of responses.
2 This organization represents approximately 45,000 physicians in more than 230 medical groups across 40 states.
3 According to the survey results, 67 percent of responding physicians rent or lease biomedical equipment that will be affected by Y2K; 62
percent of them were confident that their vendors have prepared the equipment for Y2K. Data were not provided on the remaining 33 percent
of responding physicians.
4 The survey did not have Dont Know as a response choice.
5 Twenty-eight percent of the respondents said this question was not applicable to them.

The survey results also indicated that much work remains in making biomedical
equipment Y2K-ready. Table 1 shows that less than one third of the hospitals re-
sponding to HHS OIG survey stated that all of their biomedical equipment was cur-
rently compliant, and only 6 percent of the hospitals responding to the AHA survey
stated that their biomedical equipment was currently compliant.
MANUFACTURERS VARY ON USER TESTING OF BIOMEDICAL EQUIPMENT

The question of whether to test their biomedical equipment for Y2K compliance
is a difficult one that confronts many users, such as hospitals and physicians of-
fices. FDA has taken the position that manufacturers submissions of Y2K compli-
ance certifications provide sufficient assurance of product compliance, and that such
testing on the part of users is not necessary. VA and the Emergency Care Research
Institute (ECRI) 24 have also stated that manufacturers are best qualified to analyze
embedded systems or software to determine Y2K compliance. Accordingly, they do
not encourage user testing of biomedical equipment for Y2K compliance. ECRI
guidelines, however, suggest that health care facilities should consider testing inter-
faces between medical devices in cases where the facility cannot determine theY2K
compliance of the interface from the device manufacturers.
In contrast to VHAs and FDAs positions, some hospitals in the private sector be-
lieve that testing biomedical equipment is necessary to prove that they have exer-
cised due diligence in the protection of patient health and safety. We have testified
that officials at three hospitals told us that their biomedical engineers established
their own test programs for biomedical equipment and, in many cases, contacted the
manufacturers for their test protocols.25 Several of these engineers informed us that
their testing identified some noncompliant equipment that the manufacturers had
earlier certified as compliant. According to these engineers, the equipment found to
be noncompliant all had display problems and was not critical care/life support
equipment. We were told that equipment found to be incorrectly certified as compli-
ant included a cardiac catheterization unit, a pulse oxymeter, medical imaging
equipment, and ultrasound equipment.
Our review of manufacturers web sites disclosed that manufacturers opinions
vary on whether users should test their biomedical equipment. We noted that at
least 37 manufacturers provided information on their web sites about Y2K testing.
Of these, 30 encouraged testing; 15 provided end users with information such as test
protocols and instructions. Fifteen manufacturers also encouraged users to test their
devices in configuration with related equipment to ensure that the devices operate
as intended. Seven manufacturers did not encourage testing; two of these stated
that such testing could disrupt operation of software.

24 ECRI is an international, nonprofit health services research agency. It believes that super-
ficial testing of biomedical equipment by users may provide false assurances, as well as create
legal liability exposure for health care institutions.
25 Year 2000 Computing Crisis: Action Needed to Ensure Continued Delivery of Veterans Bene-
fits and Health Care Services (GAO/T-AIMD-99-136, April 15, 1999).

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24
As we testified in May, the question of whether to independently verify and vali-
date biomedical equipment that manufacturers have certified as compliant is one
that must be addressed jointly by medical facilities clinical staff, biomedical engi-
neers, and corporate management.26 The overriding criterion should be ensuring pa-
tient health and safety.
In summary, compliance status information on biomedical equipment can be
found in FDAs clearinghouse or on manufacturers web sites. The quality of the
compliance information on the web sites, however, varies significantly, ranging from
general assurances of compliance to detailed information on specific product make
and model. Given the criticality of having medical devices function as intended on
and after January 1, it is important that FDA encourage manufacturers to provide
detailed information on the product make and model, compliance status, and avail-
ability of solutions for noncompliant equipment.
To its credit, FDA has assessed the Y2K compliance activities of 80 PHRD manu-
facturing sites. Although most appeared to have been assessed as having low de-
grees of concern, one site had a concern in two areas assessed at high. FDA is cur-
rently reviewing this site to make sure that there are no unresolved issues affecting
patient safety.
Because a significant number of health care providers are not responding to Y2K
surveys sent by federal agencies and professional associations, the public lacks in-
formation on the readiness of providers. Such information would help alleviate pub-
lic concerns about the Y2K readiness of health care providers and the biomedical
equipment they use in patient care. Lastly, although there are varying views on
whether end users should test their biomedical equipment for Y2K compliance, the
overriding criterion should be ensuring patient health and safety.
We performed this assignment in accordance with generally accepted government
auditing standards, from July 1999 to October 1999. We reviewed and analyzed in-
formation listed in the Federal Y2K Biomedical Equipment Clearinghouse. We also
reviewed and analyzed information listed on the web sites of biomedical equipment
manufacturers referred to in FDAs Federal Y2K Biomedical Equipment Clearing-
house. In addition, we reviewed and analyzed FDA documentation on the agency as-
sessments of PHRD manufacturing sites, including selected contractors final reports
to FDA on the manufacturers. We also visited five PHRD manufacturing sites and
observed FDAs contractor examiners carry out the assessment of the firms Y2K
compliance activities. We interviewed FDA officials responsible for the Federal Y2K
Biomedical Equipment Clearinghouse and oversight and management of the agen-
cys survey of PHRD manufacturer Y2K compliance activities.
Messrs. Chairmen, this concludes my statement. I would be pleased to respond
to any questions that you or other members of the Subcommittees may have at this
time.
CONTACT AND ACKNOWLEDGMENTS

For information about this testimony, please contact Joel Willemssen at (202) 512-
6253 or by e-mail at willemssenj.aimd@gao.gov. Individuals making key contribu-
tions to this testimony included Gwen Adelekun, Dr. Nabajyoti Barkakati, Michael
Fruitman, James Houtz, Robert Kershaw, Helen Lew, Barbara Oliver, Michael
Resser, Glenn Spiegel, and Glenda Wright.

APPENDIX I

FDAs List of Computer-Controlled Potentially High-Risk Medical Device Types


Classification Name

Anesthetic vaporizer
Arrhythmia detector and alarm
Autotransfusion apparatus
Automated blood cell and plasma separator for therapeutic purposes
Automated blood grouping and antibody test systemBlood and plasma warming device
Blood storage refrigerator and blood storage freezer
Breathing frequency monitor
Breathing gas mixer
Cardioconverter, implantable
Cardiopulmonary bypass heart-lung machine console

26 Year 2000 Computing Challenge: Much Biomedical Equipment Status Information Available,
Yet Concerns Remain (GAO/T-AIMD-99-197, May 25, 1999).

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FDAs List of Computer-Controlled Potentially High-Risk Medical Device TypesContinued
Classification Name

Cardiopulmonary bypass on-line blood gas monitor


Cardiopulmonary bypass pulsatile flow generator
Cardiopulmonary bypass pump speed control
Centrifugal chemistry analyzer for clinical use
Continuous flow sequential multiple chemistry analyzer for clinical use
Continuous ventilator
DC-defibrillator low energy (including paddles)
Defibrillator, automatic implantable cardioconverter
Defibrillator, implantable, dual-chamber
Device, thermal ablation, endometrial
Discrete photometric chemistry analyzer for clinical use
Electroanesthesia apparatus
Environmental chamber for storage of platelet concentrate
External counter-pulsating device
External negative pressure ventilator
External pacemaker pulse generator
External programmable pacemaker pulse generator
Fetal ultrasonic monitor and accessories
Gas machine for anesthesia or analgesia
Glucose test system
Hemodialysis systems and accessories
High permeability hemodialysis systems
Hyperbaric chamber
Hysteroscopitc insufflator
Implantable pacemaker pulse-generator
Implanted cerebellar stimulator
Implanted diaphragmatic/phrenic nerve stimulator
Implanted electrical urinary continence device
Implanted intracerbral/subcortical stimulator for pain relief
Implanted nueromuscular stimulator
Implanted peripheral nerve stimulator for pain relief
Implanted spinal cord stimulator for bladder evacuation
Implanted spinal cord stimulator for pain relief
Indwelling blood carbon dioxide partial pressure (PCO2) analyzer
Indwelling blood oxygen partial pressure (PO2) analyzer
Infant radiant warmer
Infusion pumpInstruments used to screen the blood supply for bloodborne pathogens
Intermittent mandatory ventilation attachment
Intra-aortic balloon and control system
Isolated kidney perfusion and transport system and accessories
Kit, test, alpha-fetoprotein for neural tube defects
Laproscopic insufflator
Lipoprotein, low density, removal
Lung water monitorMedical charged-particle radiation therapy system 1
Medical Neutron radiation therapy system 1
Membrane lung (for long term pulmonary support)
Micro chemistry analyzer for clinical use
Neonatal incubator
Neonatal transport incubator
Nonroller-type cardiopulmonary bypass blood pump
Oxygen-uptake computer
Pacemaker programmers
Peritoneal dialysis system and accessories
Portable oxygen generator
Powered emergency ventilator
Processing system for frozen blood
Pulse-generator, dual chamber, implantable
Pulse-generator, program module
Pulse-generator, single chamber
Pulse-generator, single chamber, sensor driven, implantable
Pump, drug administration, closed loop
Pump, infusion, implanted, programmable
Radionuclide radiation therapy system 1
Remote controlled radionuclide-applicator system 1

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26
FDAs List of Computer-Controlled Potentially High-Risk Medical Device TypesContinued
Classification Name

Roller type cardiopulmonary bypass blood pump


Software, blood bank, stand alone products
Separator for therapeutic purposes, membrane automated blood cell/plasma
Sorbent hemoperfusion system
Stimulator, cortical, implanted (for pain)
Stimulator, electrical, implanted, for Parkinsonian tremor
Stimulator, sacral, nerve, implanted
Stimulator, spinal-cord, totally implanted for pain relief
Stimulator, subcortical, implanted for epilepsy
System, pacing, temporary, acute internal atrial defibrillation
Ventilator, high frequency
Ventricular bypass (assist) device
X-ray radiation therapy system 1
Source: FDA.
1 These device classifications include radiation treatment planning systems that are accessories to these device types.

APPENDIX II
LISTING OF FOREIGN COUNTRIES WITH PHRD MANUFACTURING SITES

Argentina; Australia; Belgium; Brazil; Canada; Costa Rica; Denmark; Finland;


France; Germany; Ireland; Israel; Italy; Japan; Malaysia; Mexico; Netherlands; New
Zealand; Norway; Pakistan; Peoples Republic of China; Republic of Korea; Singa-
pore; Sweden; Switzerland; Thailandand the United Kingdom.
Mr. UPTON. Thank you.
Mr. Grob, welcome back.

TESTIMONY OF GEORGE GROB


Mr. GROB. Thank you, Mr. Chairman.
I was here in April, and at that time, you asked us all if we
thought the health care providers, whom I will talk about in my
testimony, as opposed to the manufacturers, would be ready. And
I stated that I thought they would.
I am less confident now. I think some might not be ready.
In the April testimony, shortly after that, you asked our office,
did the Senate Special Y2K Committee, to repeat the surveys that
we had done in January. We did do that in July, and provided the
copies of those surveys to you.
Overall, we found that providers reported improvements in their
level of Y2K readiness in the 6 months between our two surveys.
Approximately two-thirds of providers reported that their billing
and medical records systems were ready, compared to about half in
the January survey. Almost all the providers predicted that these
systems would be ready by the end of the year.
However, when we examined these results more closely, concerns
arose about the overall readiness of health care providers. For in-
stance, at least a third of respondents reported that they had not
yet tested their billing and medical records systems. Even fewer
had reported that they had tested data exchanges with external
vendors or said that an independent party had verified their readi-
ness.
Less than 60 percent reported that they had completed contin-
gency plans, with some providers indicating that they had no plans
to do so. Because of these findings, it causes me to view some pro-
viders assertions of complete readiness with a degree of skep-

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27

ticism. If the providers have not tested their systems, there is real-
ly no way they can be sure that the systems are ready.
With this background in mind, let me now turn to biomedical
equipment. Health care providers were even less confident in the
readiness of their biomedical equipment than other systems. Spe-
cifically, only 27 percent of hospitals reported that their biomedical
equipment was completely ready. Other provider types reported
around 50 percent of their equipment was ready.
However, it is important to note hospitals may have many more
pieces of equipment than other providers. Furthermore, even those
who said their equipment was not completely ready did say that on
average, 85 percent of it was. This indicates that hospitals are con-
fident that most pieces will function properly into the new year.
Between 60 and 70 percent of providers reported that they are
relying on the manufacturers of biomedical equipment for Y2K in-
formation. However, almost half the hospitals said that they have
had trouble getting the necessary information from these manufac-
turers. In addition to relying on the equipment manufacturers,
some providers, especially hospitals, reported taking actions them-
selves.
This is important, because the equipment needs to be working in
the real world. And I would like to address for a moment the issue
of testing. We should not confuse the need for bench testing and
laboratory with the need to test it where it is being used. Much of
the equipment needs to be connected to computers. It needs to be
connected to other systems in the hospital or the nursing home set-
ting.
And when you look on the FDA web site, and manufacturers
offer upgrades of their equipment to make them Y2K ready, those
upgrades will have to be installed and they will have to be tested
in conditions.
If I may stretch my time, just to give you one analogyif you
went out today and you bought a brand new computer in the de-
partment store and a nice office suite to bring home with you, Ill
bet you the computer would work and Ill bet you that the program
is okay. But I will also bet you that it will be several days before
you get that working in your home. It would be for me, at least.
With this in mind, then, the increased attention to the readiness
of the providers is very important. And I am hoping that this com-
mittees hearing may help rouse those who are complacent from
their unearned confidence.
[The prepared statement of George Grob follows:]
PREPARED STATEMENT OF GEORGE GROB, DEPUTY INSPECTOR GENERAL FOR
EVALUATION AND INSPECTIONS, DEPARTMENT OF HEALTH AND HUMAN SERVICES
INTRODUCTION

Good morning, Messrs. Chairmen and members of the Subcommittees. I am


George Grob, Deputy Inspector General for Evaluation and Inspections, Department
of Health and Human Services. I am here today to discuss our concerns about the
readiness of health care providers for the Year 2000 (Y2K), especially with regard
to their biomedical equipment.
BACKGROUND

The Y2K problem presents many concerns for health care providers. Not only
must providers evaluate their billing and medical records systems; they also need

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28
to ensure that their biomedical equipment will operate correctly in the new millen-
nium. Some biomedical devices, such as infusion pumps, pulse generators, blood
handling and storing equipment, chemistry analyzers, monitors, and arrhythmia de-
tectors and alarms, contain embedded microchips that perform date-sensitive func-
tions. The Y2K problem may impact the performance of these devices by shutting
down the equipment, administering the wrong dosage, providing an inaccurate diag-
nosis, or recording the wrong date.
According to the Food and Drug Administration (FDA), the vast majority of bio-
medical devices will function without any problems after December 31, 1999. Fur-
thermore, the FDA adds that most of those that do malfunction will only have minor
problems, such as displaying an incorrect date, which will not significantly affect a
patients health. The FDA concludes that only a small number of devices will have
serious operational flaws if they are not corrected before January 1, 2000. On its
website, the FDA maintains a searchable database which lists the Y2K status of
pieces of biomedical equipment as reported by the manufacturers.
Today, I wish to discuss with you the IGs work in assessing the status of bio-
medical equipment, and also highlight some of our work with regard to how Y2K
could impact health care providers.
OIGS SURVEY OF HEALTH CARE PROVIDERS

Overview
Before I talk more specifically about biomedical equipment, I need to set up some
background in order to lend context to the discussion. In April of this year, I testi-
fied before this Committee about the results of a survey on Medicare provider readi-
ness conducted by my office. That survey, administered in January of 1999, covered
a variety of issues, including billing systems, medical records systems, biomedical
equipment, and contingency planning. Your Subcommittees, along with the Senate
Special Committee on the Year 2000 Technology Problem, requested that we repeat
the January survey in order to gain an updated assessment of provider readiness.
The July survey covered the same basic areas as the initial survey, with a few
minor improvements. The surveys were developed with assistance from the Health
Care Financing Administration (HCFA) and several provider associations, including
the American Association of Homes and Services for the Aging, the American
Health Care Association, the American Hospital Association, the American Medical
Association, the Health Industry Distributors Association, the National Association
for Home Care, and the National Association for Medical Equipment Suppliers.
As with the initial study, anonymous surveys were sent to 5,000 randomly se-
lected Medicare providers representing five provider groups: acute-care hospitals,
nursing facilities, home health agencies, durable medical equipment (DME) sup-
pliers, and physicians. Response rates ranged from a high of 56 percent for hospitals
to a low of 20 percent for physicians. As I discuss the results of our survey, please
keep in mind that this is anonymous self-reported data. The advantage of promising
anonymity to respondents was that it may have increased response rates and dimin-
ished some barriers to honest repliessuch as fear of liability for unreadiness. The
disadvantage is that the data cannot be verified for accuracy. Additionally, we can-
not make any assumptions about the Y2K-readiness of those providers who did not
respond to our survey.
Overall, we found that providers reported improvements in their level of Y2K
readiness in the six months between our two surveys. Approximately two-thirds of
providers reported that their billing and medical records systems were Y2K ready,
compared to about half in the January survey. Almost all providers predicted these
systems would be ready by the end of the year.
However, when we examine the results more closely, concerns arise about the
overall readiness of health care providers. For instance, at least a third of respond-
ents reported that they had not yet tested their billing and medical records systems.
Even fewer reported that they had tested data exchanges with their external ven-
dors, or said that an independent party had verified their readiness. Less than 60
percent reported that they had completed contingency plans, with some providers
indicating that they had no plans to do so. Because of these findings, it causes me
to view some providers assertions of complete readiness with a degree of skepticism.
If the providers have not tested their systems, there is really no way they can be
sure that the systems are ready.
Reported Readiness of Biomedical Equipment
With this background in mind, let me now turn to biomedical equipment. Health
care providers were even less confident in the readiness of their biomedical equip-
ment than their other systems. Specifically, only 27 percent of hospitals reported

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that their biomedical equipment was completely ready. Other provider types re-
ported that around 50 percent of their biomedical equipment was Y2K ready. How-
ever, it is important to note hospitals have many more pieces of biomedical equip-
ment than other providers. Additionally, even hospitals whose biomedical equipment
was not completely ready still reported, on average, that 85 percent of their equip-
ment was Y2K ready. This indicates that hospitals are confident that most pieces
will function properly into the new year.
Reliance on Manufacturer Statements
Between 60 and 70 percent of providers reported that they are relying on the
manufacturers of biomedical equipment for Y2K information. However, almost half
of hospitals said that they have had trouble getting necessary information from
these manufacturers.
Four out of five hospitals who responded to our survey knew about the FDAs
website, which has a searchable database of Y2K readiness information as reported
by biomedical equipment manufacturers. Almost 60 percent of hospitals said that
they had actually been to the FDAs site. However, less that half of the other pro-
vider types knew about the site, and even fewer had visited it. On the other hand,
nearly all providers who had visited FDAs website found it to be helpful.
Testing
In addition to relying on equipment manufacturers, some providers, especially
hospitals, report taking action themselves. This is important because equipment
needs to be working in the conditions in which it is actually installed and used and
not just under ideal laboratory conditions. About 70 percent of hospitals reported
that they had tested their biomedical equipment to ensure that it would function
properly after Y2K. Less than 50 percent of other providers said that they had test-
ed. However, even hospitals have not done particularly well in getting independent
parties to verify the readiness of their biomedical equipment. Less than 40 percent
of responding hospitals and 25 percent of physicians, home health agencies, and
other providers have had third parties come in and validate the readiness of their
devices.
Survey Summary
As with their billing and medical records systems, many providers are not taking
the necessary steps to ensure that their biomedical equipment will be ready. Hos-
pitals, though reporting less readiness than the other provider groups, actually seem
to be ahead of the others in terms of knowledge and testing. Many hospitals seem
to realize that while manufacturers statements are a good starting point, relying
on them is not enough. Again, testing of the equipment is the only way that pro-
viders can assure their equipment will function properly after December 31, 1999.
OIG WORK AT INDIVIDUAL HOSPITALS

In addition to our survey work, we also have garnered information on hospital


testing of biomedical equipment by conducting interviews with a number of hos-
pitals. These interviews complement our survey results, and fill in some important
details about how providers are dealing with Y2K and their biomedical equipment.
In March of 1999, our auditors conducted interviews with representatives from 10
hospitals and 10 hospital groups representing a total of 411 facilities. The auditors
gathered information through on-site, mail, and telephone interviews. The purpose
of these interviews was to determine the efforts used by hospitals to assess, inven-
tory, repair or replace, and test biomedical equipment. These hospitals placed their
biomedical devices into one of three categories, depending on the seriousness of con-
sequences associated with its failure. The high risk category was comprised of
equipment whose malfunction could cause injury or death to the patient or operator.
The medium risk category contained equipment which may affect patient moni-
toring or lead to inaccurate diagnoses in a non-life threatening manner. Finally, low
risk equipment failures will have no impact on the patient care, but the wrong date
will appear on a report.
We found that hospitals had three main methods of determining the readiness of
a piece of biomedical equipment: the FDA website; direct communication with the
manufacturer; and performing their own tests. The hospital representatives inter-
viewed in March stated that the FDAs database was useful in determining the sta-
tus of a piece of equipment. Hospitals reported that they were relying on testing
conducted by the manufacturers in order to verify equipment readiness. According
to our respondents, only 39 of the 411 hospitals were testing equipment to verify
manufacturer statements.

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30
The preliminary results of this audit were presented to the FDA on March 31,
1999. We recommended that the FDA solicit test results from the provider commu-
nity in order to determine if their tests contradicted the manufacturer statements
in FDAs database.
On June 10, 1999, the Deputy Secretary announced that the FDA would conduct
on-site assessments of equipment manufacturers procedures for determining compli-
ance. In addition, on July 16, the FDA issued a notice which urged hospitals and
other health care providers to report to FDA any test results which differed from
manufacturer assertions.
CONCLUSION

Most health care providers report improvements in the readiness of their bio-
medical equipment and other systems. Nevertheless, there are still many uncertain-
ties about their readiness and the ramifications to patients if they are not ready on
time. When comparing our most recent survey results to the findings from the
March audit, we have hope that providers are beginning to realize the importance
of doing their own testing, and not simply relying on their manufacturers to identify
potential problems. Hospitals generally seem to be responding accordingly. We are
less confident of other providers plans and actions.
This concludes my testimony. Thank you for the opportunity to discuss the Y2K
readiness of biomedical equipment. I would be happy to answer any questions you
may have.
Mr. UPTON. Thank you. All of you did not use your full 5 min-
utes. I think that is a record.
I would just note, using your time still, Mr. Grob, that I just got
that Sega Dream Quest for my son, and with the football NFL
game. That was a couple of weeks ago, and I still dont have it
working yet. So I have to do that soon, before I lose the money.
I will recognize the chairman of the Health and Environment
Subcommittee first for questions, Mr. Bilirakis.
Mr. BILIRAKIS. Well, thank you, Mr. Chairman. I want to wel-
come the gentlemen. You have all testified, I am not sure whether
Mr. Hubbard has, but I know the other gentlemen has testified
here before. Dr. Shope, we commend you and thank you for your
real concentration on this particular problem at FDA. You have
shown that commitment in the past. And it is really good to see
Mr. Willemssen and Mr. Grob again.
However, its not good to hear what they have to say. Now, we
have all sorts of specific questions. Your last point, Mr. Grob, the
independent validations on the equipment, damned good point, ob-
viously. You have indicated your optimism of the last hearing has
plummeted. And why it has plummeted, even though your survey
says one thing, about 70 percent reporting they tested, your audi-
tors conducted specific information on hospital testing and bio-
medical equipment and only 39 out of the 411, according to the
written testimony, or roughly 10 percent, less than 10 percent of
the hospitals, responded that they were testing their equipment to
verify manufacturers statements. So it seems to me there is quite
a disparity there.
And I can maybe get to that. I guess I intend on getting to an
awful lot of specifics. But dadblast it, we are talking about people
out there who are depending on all of us. And it does not look to
me like progress is being made. I dont mind telling you, I dont get
an opportunity as often as I should to read the newspaper in the
morning. But I saw that the IBM stock, for instance, plummeted
in after-hours trading. And one of the reasons was Y2K.
Now, IBM apparently is not going to be ready. I say apparently,
because I did not go into the details and I do not know what the

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31

details are. So we have to be concerned. And Mr. Hubbard, I think


probably there is more dependence upon FDA here than any other
source. So I mean, do you have the authority that you feel you need
to make sure that all of these devices that are out there will be
safe and will be conducive to the good quality of health care? And
if you do not have that authority, by gosh, youve got to get it. You
have to check with us to make sure you have the authority.
Go ahead, sir.
Mr. HUBBARD. Well, as I say, Mr. Chairman, we believe that the
industry has assured that devices are compliant, or they have pro-
vided the means for hospitals and other users to make them com-
pliant via a software fix or whatever. But
Mr. BILIRAKIS. But sir, I just read here that 39 out of 411 hos-
pitals did not respond that they were testing their equipment.
Mr. HUBBARD. Mr. Grob, correct me. I believe the issue is wheth-
er the hospitals have availed themselves of the information that ex-
ists, that does exist, and therefore, either assured themselves that
a given device in their hospitals is compliant, or gone to the manu-
facturer and gotten the appropriate fix and included it in their
product.
I think that is really the issue. I do not think we have an issue
of lots of devices out there that may fail but no one knows about
it.
Mr. BILIRAKIS. Well, who should we expect is in the best position
to determine whether its products will operate properly? Should it
be the manufacturer? Should it be the hospitals? Who should it be,
in your opinion? I am going to ask all four of you.
Mr. HUBBARD. I will say it is the manufacturers job to assess
their device, and either notify the public that it is compliant, or to
provide a fix so that it can be made compliant. Of course, hospitals
have to, as I said, they have to avail themselves of that informa-
tion, and if they have non-compliant devices go to the manufac-
turer and get the fix, or if it is a workaround or whatever it could
be.
There are a number of things to protect themselves from the de-
vice causing a problem. But the hospital needs, if the information
is there, the hospital needs to get it.
Mr. UPTON. Dr. Shope?
Mr. SHOPE. Right. I want to clarify, I think, the statistic you are
talking about. And I think that was in response to the survey ask-
ing hospitals, have you, the hospital, done independent testing of
devices in your own facility to verify or to assure yourselves, in ad-
dition to the information from manufacturers. And I think what
the response reflects is a somewhat difference of opinion. The vast
majority of hospitals are relying on the information provided by the
manufacturer who designed the product, who has FDA oversight,
and who is providing information. There are a set of hospitals that,
in addition to relying on manufacturer information have decided
that they want, for whatever reasons, to test themselves, addition-
ally, in addition to the information from manufacturers.
It depends on the kind of product as to whether the testing in
a hospital facility is really necessary, or, I think, adds all that
much additional value over the information that comes from the
manufacturer. If a device in a hospital has been hooked into a sys-

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32

tem, made part of a system with components from different ven-


dors, and there is no one really responsible for that overall system,
of course, the hospital needs to assess how that is working, those
kinds of setups.
But in terms of hospitals relying on manufacturers information,
I think they can rely on the manufacturers information with a
high degree of confidence.
Mr. BILIRAKIS. Well, I know my time has expired, Mr. Chairman.
I would sure love to hear very briefly from the other two gentle-
men, if you would be so kind.
Mr. WILLEMSSEN. Certainly. From a provider perspective, the
first step for providers, whether they are hospitals or physician of-
fices, is to know what they have. They have to have an inventory
of their devices. And then they have to map that inventory against
available information on what the manufacturers are saying. We
think the FDA site is one good source of information. On the other
hand, some hospitals contact the manufacturers directly.
And then it is incumbent on the provider to make a risk deter-
mination, especially for critical care devices, or how much more in-
formation should we get. Should we independently test it ourselves
or should we ask for test results from the manufacturer? There are
a number of steps that they need to go through in order to make
that determination.
And it is quite a time consuming process, because once they get
that information back, they will have to go back to their inventory
and decide which items they are going to take out of inventory and
which items are going to be okay.
In addition to that, each major provider should have their own
day one strategy for the last days of December and the first days
of January. They should have detailed plans on how they are going
to respond.
Mr. BILIRAKIS. They should have.
Mr. WILLEMSSEN. Yes. They should have detailed plans on how
they are going to respond in the event that disruptions occur and
what kinds of contingencies they are going to rely on if they do
occur.
Mr. BILIRAKIS. Well, my time has really expired. But there is a
bottom line here. And the bottom line is somebody has to be re-
sponsible either the manufacturer does this, or the hospital has a
responsibility, or FDA has a responsibility. Somewhere along the
line there has to be one set responsibility to make sure. The month
of October is virtually gone. We have 2 months to go. And we have
not seen progress, it has gone the other way according to what Mr.
Grob has told us.
So Mr. Chairman, I am very disappointed. Thank you.
Mr. UPTON. Mr. Brown, I would just like to note for everyone
here, we are going to try to keep this rolling through this vote, so
some of our colleagues went to vote, they are going to come back,
so we will be able to vote, hopefully.
Mr. Brown.
Mr. BROWN. Thank you, Mr. Chairman.
The last 8 or 10 months, I have been impressed listening to testi-
mony and in reading testimony and reading and looking at other
things that Government agencies such as HCFA, such as FDA,

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such as Social Security Administration, others, are pretty well pre-


pared for Y2K and have done a lot to sound the alarm for private
sector agency, private sector groups, whether it is banks or Social
Security or the providers that you work with for those private sec-
tor groups to be ready.
But I am disappointed, and this is my reason for concern, espe-
cially the comments of Mr. Grob and Mr. Willemssen, of the re-
sponse rates from the private sector, the HHS, the Inspector Gen-
eral, sending surveys to nursing facilities, home health agencies,
physicians, all had less than 50 percent response. The AHA, the
Hospital Association, had, I believe, a 29 percent response, accord-
ing to the testimony of, this was the GAO testimony. And the AMA
had an even poorer response of 8 percent. Thats a cause for major
concern.
Then I listened to Mr. Grob say that the significant amount of
equipment is not, even of the ones that have responded, a signifi-
cant amount of equipment is not ready, the providers tell you. And
then I heard Mr. Grob say, talk about drawing the distinction be-
tween the generic Y2K or susceptibility of a particular device, and
how actually that device might function in the real world. I think
your analogy with computers was something I could even under-
stand, so thank you for that.
What does all this mean? Mr. Grob, does this mean that, what
are you expected to do when you cant get this kind of response
from the private sector and people love to blame Government for
everything, but it seems that Government agencies have done this
right, and if Government agencies had done as poorly as the pri-
vate sector seems to have done in this, we would have you in front
of this subcommittee beating you up hourly instead of just every
month or 2 or 3.
Talk through that, if you would.
Mr. GROB. I think we just still need to keep beating the drums
here. I think that it is the last part of the game now, and it is
going to require a full court press to make it happen. The respond-
ents all said they will be ready, and I certainly think they can be
ready. The question now is simply a matter of getting ready. And
I think the process right now isnt that hard. I do agree that the
Food and Drug Administration and others have done a good job of
providing tools for people to be ready.
And I must say, with respect to the health care industry, I really
have to point out that the various provider groups that are men-
tioned in my testimony did help us with the survey. They did en-
courage their members to respond. We even got responses from
people we did not send the surveys to, I think as a result of their
doing that.
Mr. BROWN. Their umbrella organizations, the associations.
Mr. GROB. Exactly, right. So we appreciate their help in doing
this. And there is a lot going on.
I just think that there might be some complacency, maybe some
insensitivity or lack of understanding, and perhaps this hearing
and just everyone continually beating the drum on this should be
the case.
As far as the readiness is concerned, the testing we are talking
about, the real world testing is going to occur on January 1, 2000.

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There is just no need to wait until then. It can occur earlier than
that. It is just, I think, a matter of doing it. The tools are there,
it can be done.
Mr. BROWN. Mr. Willemssen, do we have enough information to
be able to predict if we will have failures? And will we have enough
information if we do not know?
Mr. WILLEMSSEN. I think the more that weve got into this, espe-
cially in these key sectors, and as the unknowns intensify, the un-
certainty also increases. One thing that weve done when we do
surveys is we have been a large proponent of publicizing the names
of non-respondents. When we did surveys, for example, on 25 large
school districts, the 21 largest cities in this country, and State sur-
veys, we have told the respondents that you are free to respond or
not respond, but we are going to publicize that fact one way or the
other.
The response rates for 25 school districts were 100 percent, for
the 21 largest cities, it was 100 percent, and for all States, all
States responded except one. In my opinion, letting them know in
advance that if they dont respond we are going to publicize the in-
formation has been a crucial factor in enhancing the response rate.
Mr. BROWN. Are you confident that of the failures that perhaps
are inevitable, at least some number of them, in the types of equip-
ment, that where there might be failures, are you comfortable that
there will be at least, that we will not see critical failures that
might cause death or severe injury in equipment where that might
happen?
Mr. WILLEMSSEN. I am more comfortable of that today, actually,
than in the May hearing, because of the efforts FDA has under-
taken with the critical high-risk devices, and the work that it has
done at selected manufacturers. This gives us a higher degree of
comfort for those critical care and life support items. So I actually
am more optimistic today on this particular subset.
Mr. BROWN. One last question real quick, Mr. Chairman, if I
could. What grade would you, A meaning they have absolutely done
things right, F meaning they have absolutely done nothing right,
what grade would you give the provider community regarding their
Y2K readiness?
Mr. WILLEMSSEN. Incomplete.
Mr. BROWN. You have to do better than that.
Mr. WILLEMSSEN. If I had evidence on what the data showed in
terms of preparedness, I think I would be in a position to give a
grade. But the biggest compelling factor is unknown.
Mr. BROWN. But if it is incomplete on December 31, it is an F.
Mr. WILLEMSSEN. Well, it depends on who is incomplete. Those
providers may know very well where they stand, but they choose
not to provide the information to others.
Mr. BROWN. Okay, thank you.
Mr. UPTON. We will just adjourn temporarily here until Mr.
Greenwood comes back, and he can continue the hearing. We have
to go vote.
[Brief recess.]
Mr. BILIRAKIS. This was a general vote, a very important vote.
I believe it is Mr. Bryants turn to inquire. Please proceed, sir.
Mr. BRYANT. I thank you, sir.

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I think Mr. Willemssen and Mr. Grob, to some extent, well, not
to some extent, very extensively, in Mr. Grobs testimony, talked
about the testing issue. That is something that is very near and
dear to my heart, because I have constituents who are in the hos-
pital business come up to me and say, well, should we test these
or not. And our lawyers worry about that, because if we test it,
then maybe we are making ourselves more liable if something
should fail. Or on the other hand, if we do not test it, are we also
making ourselves liable if we do not test it.
And that is an issue that will have to be decided outside of these
four walls at some point. But the liability protection bill that we
passed for Y2K purposes does really concern the two parties to the
contract, and whether the computer works or not, the microchip or
whatever.
But the third party lawsuits and the potential that we are not
dealing with just business records or just in commerce documents,
but we are dealing with human lives, potentially, here, concerns
me. So let me turn to the FDA if I could and ask you, I see a very
clear cause of action to an injured third party, a patient that is in
a hospital or a patient that has some sort of device that FDA has
approved. And if it is not Y2K compliant, I see some lawsuits here.
Beyond the lawsuits, though, what is FDAs role, and what has
it been in identifying last year or 2 years ago that, hey, there are
some problems here, and before we give the FDA stamp of ap-
proval, it has to be Y2K compliant. Because again, some of these
devices you have approved could affect a human life dramatically.
Were those steps taken a year, 2 years ago, 3 years ago, when this
Y2K issue came up? Were they taken to ensure that everything you
have approved the last several years since this issue has been iden-
tified, does the FDA stamp of approval mean that they are Y2K
compliant, and if it does not, why not? What assurance is the FDA
approval if it is not Y2K compliant?
I might also add, why was it not done if it was not done, but is
it being done now, and is there any effort to, once you have identi-
fied these problems, to recall these things before we have people in-
jured or die as a result of this?
Mr. SHOPE. There are a couple of pieces to that, let me try to
work our way through those. First of all, we began to pay attention
to the Y2K issue around the middle of 1996, in terms of raising the
issue in the agency and saying, we need to pay attention to the im-
pact of this issue on devices. At that point, we discussed with our
pre-market review staff the need to pay attention to this issue in
terms of new submissions.
But I have to say that technically, a manufacturer could today
even bring a product to market that was not Y2K compliant. Let
me give you an example of what I mean by that. If that product
is accurately described in labeling, if the user instruction accu-
rately describes the manual operation that needs to be done, say,
on Leap Year day, to reset the clock, and that is acceptable to the
purchaser in terms of, I can buy a product that is described like
that and make it work, then there is not a requirement that de-
vices coming to market now be Y2K compliant.
There is a very small chance that manufacturers are going to
bring a product to market like that and we are not seeing manufac-

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turers bringing us products that are not Y2K compliant. But if a


manufacturer, say a small company, has a product that has been
on the market for several years, he is developing a fix that his next
model will have, but it is a very minor kind of a problem, he would
be free, under our approach right now, to relabel, to basically
change the labeling and the description of that product to lay out
clearly the non-compliant nature, the small non-consequential kind
of problem that it has, and the user actions necessary to repair
that and continue to market the product like that.
Mr. BRYANT. Let me stop you real quick. The user actions to
reset that on the Leap Year, on January 1, are you expecting the
patient to, if it is an implant, I mean, were not really talking about
that?
Mr. SHOPE. No, there are no implants that are affected by the
date problem.
Mr. BRYANT. Are you expecting a patient to affect a medical de-
vice, or is the doctor supposed to tell him, youd better be back in
here on midnight, so I can test you?
SHOPE. No, no. We are talking about typically displaying the cor-
rect date, and that is all the device does. The manufacturer would
have to go through a risk analysis to evaluate any risk associated
with this date non-compliance, not a regulatory non-compliance.
And if he can come to the judgment that the non-compliance pre-
sents no risk to the patient, no additional risk, no change in the
impact on safety or effectiveness of the device, that is the condition
under which this non-compliant product could continue to be mar-
keted.
I think it is only the rare circumstance of manufacturers who
have an existing product that has a very minor problem, and they
would like for the economic reasons to continue to produce that
product, and buyers are willing to buy it under those cir-
cumstances, then that would be possible. But the vast majority of
manufacturers have already corrected their products, and that is
what they are selling now. They are not selling the product that
still has a problem. They developed the fix, and their current mod-
els have the fix available.
There are some manufacturers that have identified a Y2K prob-
lem that is a very minor problem, and they have told their cus-
tomers, this product has a problem, it is minor, we are not going
to offer a fix, live with it, basically. You can, it does not introduce
any risk to patients. It means the date printed or displayed is not
correct.
Let me also add, maybe I can put a little bit of context here, a
number of the large hospital systems that we have talked to about
their Y2K efforts, investigating their products and remediating
their products, we are talking about very large systems that have
hundreds of thousands of medical devices. Several have told me
personally that, we have not identified any product other than one
or two types in our entire inventory that would put a patient di-
rectly at risk due to a Y2K problem.
The radiation treatment planning systems are well known. There
are a few models of the older types of those systems that do need
to be replaced, they could lead to inappropriate radiation therapy.
But as far as devices that fail and their direct failure having a di-

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37

rect impact on patients, we are just not aware of devices that


present that kind of a problem due to Y2K that would warrant
FDA immediately taking the kind of regulatory action that we can
take in those circumstances when there is an immediate risk to pa-
tient health.
So there are certainly a lot of computer-controlled systems,
record keeping is done, but devices that use dates and calculations
that present a problem if that date calculation is inappropriately
done, the manufacturers have addressed, have identified those,
have provided fixes, and the hospital, the user of those types of
products have to avail themselves of that upgrade in order to con-
tinue to use the product.
Mr. BRYANT. Mr. Chairman, I see my time is up, and I will not
ask for additional time. But I would hope that GAO and HHS, if
they get a chance to comment during the answering of other ques-
tions, they might comment on that, too. I think that is very impor-
tant. Thank you.
Mr. BILIRAKIS. It is important. We will recognize Mr. Greenwood
at this point, and hopefully get to that.
Mr. GREENWOOD. Thank you, Mr. Chairman.
I would like to address a question to Mr. Hubbard, if I might.
Would you describe for this panel the type of information that FDA
has with respect to individual specific devices, either through prod-
uct approval applications or through reporting and accountability
requirements, pursuant to FDAs quality system regulation about
specific devices, and then the follow-up question is, do you need
more information?
Mr. HUBBARD. I think that is a better question for Dr. Shope, if
you do not mind, Mr. Greenwood.
Mr. GREENWOOD. All right.
Mr. SHOPE. We have basically two types of information I would
characterize. One is our registration and listing database, which is
manufacturer supplied information that tells us who is in the busi-
ness of making medical devices and the types of products that they
make. This is the basis for our inspection program, knowing where
the factories are and what is made at those factories. The second
kind of information we have is the premarket approval submissions
that come in from manufacturers, that are the information that de-
scribes the products in terms of their safety and effectiveness for
the premarket notifications, their substantial equivalence to exist-
ing devices, or for pre-market approval applications, the more de-
tailed scientific and technical data that show their safety and effec-
tiveness.
Mr. GREENWOOD. Let me interrupt you for a second. Has FDA
ever required that in those submissions, there be Y2K specific in-
formation?
Mr. SHOPE. Oh, yes. If it is the kind of device currently that
would be relevant, that is certainly a question that is asked during
the review process.
Mr. GREENWOOD. For how long has that been the case?
Mr. SHOPE. Since mid-1997 I would say.
Mr. GREENWOOD. Okay.
Mr. SHOPE. But we also, I have to point out, to be clear about
it, there were some products that came to us in 1997 that the man-

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ufacturer had in development for several years, and they said, this
product is not Y2K compliant, but we will have an upgrade by 1999
that will be, and we will provide that at no cost to the users. So
there was no reason in the marketplace sense to deny that firm ac-
cess to the market for that product.
So we did make a few of those types of decisions, but not a large
number of them.
In terms of our database, we do not get, in our record keeping
system in a computerized fashion, access to information readily
available about, is the device computerized, what is the type and
nature of that computerization. So that is not readily available to
us from a database type approach. We have to rely on the manufac-
turers to tell us, I make this kind of a product, and it is computer-
ized in some sense.
Mr. GREENWOOD. Do you feel you need that information?
Mr. SHOPE. I am not sure how we would use that thorough or
detailed information, the staff to stay on top of that kind of infor-
mation I think would be a challenge. I think when we have a
specific
Mr. GREENWOOD. Do you think there is any risk to the public be-
cause you do not have that information?
Mr. SHOPE. No, sir, not currently. Because any time there is a
specific device that has an issue, we do have the complete descrip-
tion that we can go to and hone in on it. When we have had this
question of all devices all at once, it has been a challenge. And then
we relied, going back to the manufacturer, who best knows the de-
vice, to give us that information.
Mr. GREENWOOD. Does that complete your response, sir?
Mr. SHOPE. I am trying to remember if I covered all your points.
Mr. GREENWOOD. Let me address a question for Mr. Grob. In
your opinion, who is in the best position to determine whether a
device will be impacted by the Y2K issue? As you know, FDA and
the device manufacturers on our second panel are very concerned
about hospitals conducting independent validations on equipment.
How do you respond to the concerns raised by FDA and the device
manufacturers?
Mr. GROB. I think, this is an opinion, it is not a legal opinion,
it is a personal opinion, because I have not delved into the liability
issues. My work was restricted to the surveys and related issues.
But my opinion is that it is the provider that is in the best position
to know whether the equipment works. Because they are going to
know on January 1, 2000, no matter what happens in between,
they are going to know on that day.
There is not any reason why they do not know before then, not
a good reason. The information is generally available, so they
should just find out and get ready.
So I really think that is where the knowledge ought best to be.
I think you asked me a second question.
Mr. GREENWOOD. How do you respond to the concern that the
providers may not have the expertise to validate in advance? You
certainly do not know if the lights go off on January 1.
Mr. GROB. Right. I think this is probably the most important dis-
tinction that is coming about as a result of the survey work that
we did and the discussions that we are now having. I think that

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there was quite a bit of policy discussion as to who should be re-


sponsible for the testing of the equipment. And both FDA and the
manufacturers were coming on the side that that should properly
be done by them, because of the need to carefully calibrate it,
and
Mr. GREENWOOD. By them, you mean?
Mr. GROB. The manufacturers.
Mr. GREENWOOD. By the manufacturers.
Mr. GROB. I do not disagree with that at all. I have to defer to
them on that matter, as to the proper procedures for testing.
What I am trying to focus on is the testing that has to occur in
real life. Let me give you an example, if I can. There was one piece
of equipment that was listed on the FDA web site, and it reported
that it was a minor problem, because the date would be displayed,
but it was okay, it was two digits and 00 would mean year 2000,
in other words, it was not incorrect, it was not calculating wrong,
everyone could understand that, but you just needed to be alerted
to that.
They then added the following caution: however, if you connect
this piece of equipment to another computer in your outfit, and the
date is processed by that computer, you really do not know how
that computer is going to process the two-digit date that it gets, be-
cause that equipment may not be ready or it may not be used prop-
erly. So they now caution the provider that you need to check that
out for yourself to make sure that is okay.
It is that kind of testing that I am talking about, it is when you
write in to the manufacturer to get your free upgrade, you have to
get it, you have to install it, you have to shake it down. So perhaps
the word testing means different things to different people. In the
way that I am using it, I certainly mean it in the terms of what
I would call real life testing.
Mr. BILIRAKIS. The gentlemans time has long expired.
Without objection, we will give an additional 2 minutes to Mr.
Bryant. Well, before we do that, is there somebody else here? Mr.
Brooks?
Mr. BARRETT. Thank you, Mr. Chairman.
I Just have a couple of questions. Mr. Willemssen, maybe you
can help me out. After looking at a lot of todays testimony, I am
still not sure that I have a precise picture of what it is we want
both the regulatory agencies, FDA and the device manufacturers to
do to ready themselves for January 1. If you could, what two or
three major recommendations would you make to the FDA at this
point, and why?
Mr. WILLEMSSEN. One is for those manufacturers who provide
links to their web sites. FDA should request that these manufac-
turers provide detailed information on product make and model in-
formation. Second, FDA is in the process of putting together a re-
port on the efforts that it has undertaken on critical care and life
support devices. I believe that report was initially expected to be
out October 1. It is not out yet.
FDA needs to commit to a date as soon as possible, so that the
American public can get a sense of what level of risk there is on
those critical care and life support items. In addition, as part of
that effort, I would publicize all 803 manufacturing sites. I would

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publicize the names of all 325 that were in the initial sample. I
would publicize and disclose those who decided not to participate
in the exercise. We have a few other suggestions, but those would
be among the most important ones.
Mr. BARRETT. What about the device manufacturing industry?
What recommendations would you have for them?
Mr. WILLEMSSEN. I think it fair to say that I come out a little
bit in between the Inspector General and FDA. I think from a pro-
vider perspective, the first thing you have to do is go back to the
manufacturer and see what the manufacturer is saying.
In many cases, the manufacturers are providing details on their
web sites, on how to go about testing the equipment, including test-
ing hook ups to other equipment. I am a little reluctant for pro-
viders to just go out and test without having that kind of informa-
tion in hand. The ideal is for a partnership between manufacturer
and provider to test in a real operational environment. This will
give you the best result.
Mr. BARRETT. What about the users, the hospitals, the doctors,
nursing homes? Are there things they should be doing now? What
would recommendations would you have for them?
Mr. WILLEMSSEN. I would certainly hope that they have already
taken these steps. But if they have not, they obviously need to
know what they have in their inventory. They need to match that
inventory up against available information from sources such as
the FDA clearinghouse. Then, based on that, look at what their
critical care and life support items are and what kind of steps they
need to take to assure themselves that these are going to work as
expected. Those steps could entail independent testing on their
own, or asking manufacturers to give them their own independent
test results.
Those are the kinds of steps that should have been taken by now.
I fear in some cases they may not have been taken by some pro-
viders.
Mr. BARRETT. Do any of the other panel members want to com-
ment on any of the suggestions?
Mr. GROB. Yes, I do. I just want to clarify, there is no disagree-
ment in policy regarding testing at all. I have never advocated and
I am not advocating now that the providers substitute their bench
testing for that of the manufacturers. The way Mr. Willemssen put
it is exactly what I would agree with. The providers need to get the
best information they can get, which probably is initially going to
come from the manufacturers, then they have to absorb it, and
then they need to make sure it works in their setting.
Mr. BARRETT. I would yield back my time.
Mr. BILIRAKIS. If you would yield. Well, here it is again, near the
end of the year, and we are about to finish up in 3 weeks, who
knows. I am not sure that God knows.
Mr. UPTON. He does know.
Mr. BILIRAKIS. He does know? He has not told us.
But the thing is, is there anything that we can do at this point
in time, yes, the providers have the equipment and I have, I think
we all have a sense of confidence in providers that they want to
practice good medicine and they care about these things. The thing

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that concerns me is the lack of responses from the hospitals regard-


ing your survey.
So is there anything that we can do to help FDA, to do this job
better, considering that our session is virtually over, and by the
time we get back in again, it will be after January, or after the end
of the year? Mr. Hubbard, can we help you in any way? I know you
are concerned about it, on top of all your other responsibilities, you
have this, too.
Mr. HUBBARD. Mr. Brown was talking earlier about the poor re-
sponse rate from hospitals, and he is absolutely right. I will say
that from the manufacturers, we have almost 100 percent response
rate. So we have very good information about what the manufac-
turers have done.
The providers, the hospitals, do need to avail themselves of the
information. As a legislative body, I do not know how you help
make that happen. But the hospitals and other health care pro-
viders do need to seek out that information and make sure that the
devices they have in their institutions are compliant, or if they are
not, they need to go get the fix and get it put into their device.
That seems to be the challenge, given the response rates that the
others have been receiving from those providers.
Mr. BILIRAKIS. Thank you.
Mr. Upton to inquire.
Mr. UPTON. Thank you, Mr. Chairman. I do not know if my com-
fort level is getting better or worse from the hearing that we had
last spring. I thought that this was certainly a good topic. I visited
with a number of my providers, both private practitioners as well
as device manufacturers as well as hospitals, and asked the Y2K
question almost everywhere I went.
And I use the analogy, I have a smart little daughter. She is a
sixth grader, she is very honest and she is very smart. And my
guess if that if her science teacher asked her if she had done her
homework, asked everyone in the class if they had done their
homework or not, excuse me, if the teacher asked, did any one of
you not complete your homework, probably some people in that
class might not raise their hand, particularly if they knew that the
teacher was not going to check.
And Mr. Hubbard, as I listen to you, you just indicated that you
had almost 100 percent compliance, I look at 132 providers who are
on the internet, never responded at all. I do not know if anyone has
gone to their door and said, did you do your homework or not.
At the beginning of your testimony, you indicated, and I did not
write it down word for word, but you said that no, there were no
manufacturers with high concern, in essence, not a single one. Yet
Mr. Willemssen in his testimony a couple of minute later said, in
fact there was one major device manufacturer, is that not correct,
who you identified this week, and they told that to the FDA, is that
not right, Mr. Willemssen?
Mr. WILLEMSSEN. There is one that FDA informed us of as part
of their evaluations and assessment.
Mr. UPTON. If I may, I would like to defer to FDA on the naming
of that particular organization.
Mr. UPTON. Mr. Hubbard?

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Mr. HUBBARD. Under your act, we have promised these groups


not to reveal information about these. Is that something perhaps
we could talk with the committee about privately?
Mr. UPTON. I will accept that, but does that not contradict what
you said in your statement?
Mr. HUBBARD. First of all, Mr. Chairman, I was focusing on the
firms that really matter here, the priority firms, those that make
very important products that if they fail could cause harm, drugs
that if not available could not be available elsewhere. The 132 you
are referring to, if I am correct, and I will ask Dr. Shope to elabo-
rate, are firms that we have not been able to find. We do not think
they exist.
There was a much larger number of those that never responded
to us, the addresses were wrong or whatever, they come from a reg-
istration system that we employ at FDA, but it depends on the
manufacturer
Mr. UPTON. Can you put an APB out on these folks? I mean, they
had a place at one time that certainly maybe still today employ
people, and they have a manufacturing site, and their equipment
is all licensed.
Mr. HUBBARD. We do not believe they exist. If Dr. Shope would
like to elaborate.
Mr. SHOPE. Well, that is partially right for some of them. Some
of them
Mr. UPTON. We do not have the addresses for any of these?
Mr. SHOPE. We have diligently tried to contact all of those folks.
There are some there that are definitely, clearly out of business.
They were out of business in our database when we started. We
were not fine enough in our filtering of our database to eliminate
those. When we went out with the broad brush for 13,000, we tried
to get everybody. We tried to be all inclusive and not miss any po-
tentials. So we knew that our database was not perfect.
There are also people on that list who are only distributors of de-
vices, they do not make anything. There are also manufacturers on
that list who probably make no computer products, and we have
looked at that list carefully. There is not really a strong incentive
for them to respond to us. We have not sent inspectors to each
door, but we have looked at the list, looked at who the manufactur-
ers are, what kinds of products they make, and there are not areas
of large concern there for us.
Mr. UPTON. Well, Mr. Willemssen indicated in response to a
question by Mr. Bilirakis that he thought that the FDA should be
responsible in making sure that those manufacturers would follow
up, and that the FDA should be responsible to make sure that in
fact that happened. Do you feel that you are responsible for their
actions, and have you thought about recalling any of their products
for those that may not fit that definition?
Mr. SHOPE. We do not know of any of those manufacturers that
have products that would raise any kind of concern that would lead
to the situation of a recall. We also have to say that we have not
heard people saying to us, we cant find this firm, there is no infor-
mation available about this product. In general, we hear that for
a few firms, and I know of several where they have not been real
cooperative. But they do not make a kind of product that would fit

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the risk of a high-risk device that would warrant a recall. They are
the aggravation kind of Y2K problems that the firm has not dealt
with.
So I do not have a lot of concern about the firms on that list. We
will continue to look at them as we finish our work with this list
to make sure there is nobody there that makes the kind of product
we will be concerned about.
Mr. UPTON. If I can just ask one quick follow-up to my initial
question, were there other manufacturers, other than this one firm
that Mr. Willemssen indicated that you all knew about that you did
not mention in your testimony, is it only one?
Mr. HUBBARD. Yes, Mr. Upton. The audits were very intensive.
They lasted three or 4 days. They were done by very skilled IT pro-
fessionals, and they were very intensive.
This one firm had some lower documentation than this very high
standard required. So when the auditor reported back to us that
they had concerns, we then sent FDA investigators to the firm who
did a full examination under FDAs legal authority. They found
that the firm had adequate contingency plans, that the firm was
attending to the problems, and that there were no serious health
concerns here.
There were some documentation, other paperwork concerns, that
caused the auditors to flunk them, as it were, but the subsequent
inspection has given us confidence that that firm is not truly a
problem. However, we will continue to watch that firm as well.
Mr. UPTON. I yield back my unexpired time.
Mr. BILIRAKIS. Without objection, the Chair yields an additional
minute to Mr. Bryant to get a couple of responses he was looking
for.
Mr. BRYANT. Thank you, Mr. Chairman. I am kind of like Mr.
Upton, I am not sure whether I feel better or worse after this hear-
ing. But I do get a general sense that perhaps the Inspector Gen-
eral and GAO do not feel as comfortable as the FDA does on this
matter, that maybe they feel it is a little worse.
Just very quickly, I might ask, I think maybe I will cover the an-
swers a little bit more than I asked for. Very quickly, Mr. Grob,
if you can tell me, do you pick up what I pick up nationwide, what
I pick up in my district, the concern from the providers of whether
or not to test these devices, and so forth, because of liability? It
seems to me the stronger case is if you do not do anything, you are
better off than if you test it and then it goes bad. It seems like
from a lawyers standpoint.
But is that concern out there? Do either one of you at GAO by
any chance hear that?
Mr. GROB. Let me address that in a variety of different ways.
First of all, with regard to liability, the reason we did our report
anonymously, and we did talk to this committee about that, which
we also did the first time, was so that we would get a good re-
sponse rate. We had been told that people were reluctant to even
respond to our survey by name, if they were to be advised that
maybe some answers they gave could create a liability problem for
them.
So we used this approach, and actually, it turned out to be effec-
tive. Our response rates are nowhere near what we want them to

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be, but they are still double or triple what most surveys in this
arena get. So at least it gave us a bigger view inside than before.
So I think liability was certainly, that was evidence, I think, that
the liability was on peoples minds. Again, I am really guessing
here now, I will venture a bit of one. I think the liability matter
was more of an issue earlier. Because according to our survey, the
hospitals particularly seemed to be doing a lot of testing. Those
that did respond seemed to have a pretty ambitious program.
And where they report now, no change, even a slight dip in the
overall readiness of all their equipment, their answers to other
questions indicate that the hospital industry seems to be pretty
systematically checking everything out and doing things other than
just relying on the manufacturer. They seem to be relying on their
own actions as well.
So that does actually inspire a lot more confidence. The hospital
industry has the biggest problem. They have the most and the most
sophisticated equipment. And they seem to be most methodically
going after it. Perhaps in some of the other groups there may be
more complacency among say, nursing homes, home health, physi-
cians, durable medical equipment manufacturers, etc., on this mat-
ter.
So what I really see now is just a matter of keeping up the inten-
sity of the effort right now, of making the full court press, here in
the last quarter of the year.
Mr. BRYANT. Mr. Hubbard, very quickly, of the 80, I think, con-
tractors you assessed, some 14 were located in other countries, 8
other countries. How about those foreign manufacturers?
Mr. HUBBARD. They were also visited. We actually sent auditors
to those firms in those countries and did the same audit we did for
domestic firms. And they had to meet the same high standard.
Mr. BRYANT. And they passed?
Mr. HUBBARD. Yes.
Mr. BRYANT. Good. Thank you, sir. Thank you, Mr. Chairman,
for your generosity with the time.
Mr. UPTON. You are very welcome.
Mr. Brown has a couple more questions.
Mr. BROWN. Just one more question, Dr. Shope. I sit here and
as the hearing evolves, I went from a good deal of confidence to less
confidence as I have listened for the last 112 hours or so. I am real-
ly perplexed by this whole situation, first of all, the lack of re-
sponse to surveys that you have issued, asked people to return,
that you have too little information, that there is an incomplete
score card in Mr. Willemssens response. And from Mr. Grobs com-
ments, that there is just little experience in how this will work in
the real world.
So for some senior citizen or anybody for that matter listening
at home to this or watching this at home, I have to think they are
very confused about all of this. And then Dr. Shope, I hear you say
that you are confident that there is not going to be serious injury
or death from any piece of equipment that might not function the
way that it should because of Y2K.
Assure me, if you would, why that will not happen.
Mr. SHOPE. My opinion is based on the kinds of products that
have date problems and the nature of those date problems, and

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45

that those kinds of failures will not directly impact the patient di-
rectly or immediately. The vast majority of the Y2K problems we
are talking about have to do with record keeping, historical records
of what the device did as opposed to being involved in the device
functionality.
There are certainly, though, some devices that do use dates and
computer calculations. It is a rather small number of devices where
that is true, and those have been well addressed by their manufac-
turers. Those are the kinds of manufacturers who have commu-
nicated to each and every one of their customers about the issue,
and in many cases have provided free upgrades because of the risk
associated with this, the manufacturer wants no liability that they
have left any stone unturned to address this issue.
So I think it is the cooperation between the industry recognizing
their exposures to other than just FDA that has given this kind of
a problem the kind of attention it needs.
I think the industry has well responded to this issue. If there is
a place that continues to need attention and concern, I think it is
the health care facilities that need to complete their assessment.
Mr. BROWN. Exactly. Mr. Grob, what you said, and this is my
last question, Mr. Chairman, you talked about, Dr. Shope just men-
tioned that the manufacturers have worked out all the problems
potentially in his opinion. But you had talked about the interaction
between two computers. One is Y2K ready, the manufacturer or
maybe the health facilities is not, one of those health facilities that
is not responding to your questionnaires or your surveys.
Are you concerned about the issue of some serious injury because
of that interplay?
Mr. GROB. I just do not know about how serious it would be. And
for that, I really have to defer to FDA about the nature of the
equipment. Again, I think it is true that most of the problems that
are reported on the internet are primarily the reporting of data, or
the reporting of dates, which could be inaccurate. Sometimes that
reporting of dates can affect the way the equipment functions or
some of it may not function at all, because the computer cannot fig-
ure out the date, and they actually report some gibberish there.
But whether or not any of that will relate to a serious health
problem for an individual, I simply cannot address that. My sense
from what FDA is saying is that they do not see any evidence of
that.
It is just that you do not know, and there is not any reason not
to know. It is a fairly straightforward matter, I think, to just try
it out. That clearly is just something that should be done.
Mr. BROWN. Mr. Willemssen, do you have an opinion on that?
Mr. WILLEMSSEN. Only to say, as I briefly mentioned, I believe
on the high risk devices, I am more optimistic now than I was in
May. This is because FDA is taking additional efforts that it origi-
nally did not plan to take, and it will have additional independent
evidence of where those manufacturers are.
Mr. BROWN. Okay, thank you. Thank you, Mr. Chairman.
Mr. UPTON. Thank you.
I have just a couple of questions, and I would like each of you
to respond to this. This sort of goes to the heart of the concern by
all members on this committee. It is my understanding that the

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46

FDA identified 803 manufacturers with potentially high risk de-


vices. And in an effort to see where things were, identified 325 of
those trying to do a random test to see exactly where things were.
Of those 325, 197 had no computer chips, so everything is fine,
scissors, whatever it might be. Eighty of them said yes, but we are
okay, 80 of those said yes, we do have a computer chip. Eighteen
were duplicates. I would subtract that as well. Four did not re-
spond at all. And 26 said, we are not telling. We are not going to
participate. And going back to my student-teacher analogy, that
student would probably be sent down to the principals office. But
26 said, we are not going to say yes or no, we just aint saying.
And I just, you know, as we look for the comfort level here, Janu-
ary 1 is not all that far down the road, we are all sort of figuring
out where we are going to be that day. Mr. Grob, what is your com-
fort? Knowing those stats and knowing that is about a little less
than half the sample, do you think everyone has done their job on
this?
Mr. GROB. You asked me that before and I changed my mind on
the answer.
Mr. UPTON. You know, on one hand, on the internet, some of
these, a lot of these maybe have shut their doors. But at the same
time, we have a number of firms who are not on the internet, no-
body knows, maybe FDA knows for sure, but other folks do not
know who these manufacturersand they have already been iden-
tified as high risk device manufacturers.
Mr. GROB. Could I add some speculation to the survey work?
Mr. UPTON. Sure.
Mr. GROB. My speculation would be that in a hospital setting,
the hospitals would be pretty sensitive to the equipment that could
cause harm if they did not check it out. Really, really big harm. So
I think that alone would be a good force that would help people to
check it out.
I think for other things they are trying now to get it all checked
out, and that is a big logistical problem for the hospitals. But I do
think that generally they are trying to do that. Although I do de-
tect, myself, some complacency that is unwarranted in that regard.
I think in the other provider groups, I detect much more compla-
cency, or a feeling that someone else will take care of it, when I
dont think that really will solve the problem.
So my report card, I would have to do like in history and math
have different grades, I would give the hospitals maybe a B, others
C, D, depends on the question.
Mr. UPTON. Or do not know if they turned in their homework?
Mr. GROB. Or dont want to answer the question as to whether
they have done their homework, right.
Mr. UPTON. Does not work for my sixth grader.
Mr. Willemssen. I will go back to what I mentioned a little bit
earlier, in that I think FDA should name the names of the 803
sites, name the names of those who declined to participate.
Unfortunately, FDA should have let them know that in advance.
And I would guess that they would have had a lot fewer declina-
tions than they did if they had let those sites know that they were
going to publicize what the response was.

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Mr. UPTON. Now, in your own investigation, do you know who


these 26 firms are?
Mr. WILLEMSSEN. Yes, we know who the 26 are.
Mr. UPTON. Mr. Hubbard, I came to you last by design.
Mr. HUBBARD. Let me say, Mr. Chairman, that all of those firms,
those 325 firms, have reported to the FDA web site, the clearing-
house. So we know what devices they have that are compliant or
non-compliant. So it is not like there are unknowns.
Most of them ask not to be given an audit because of various rea-
sons, they were trying to get their Y2K work completed and other
things. And those reasons may have been very legitimate.
However, we still are looking at those firms to make sure they
do not make products that are of concern, and if we find that there
are some that could be a concern, and they still say no, they may
get a visit from an FDA investigator who, as you know, has legal
authority to enter that firm and do a full inspection. So we are not
really concerned that those folks will not get a look.
Mr. UPTON. Have FDA inspectors actually gone to any of these
identified 26 firms?
Mr. HUBBARD. So far, we have reached a level of concern on only
one firm that triggered an inspection by an investigator. All the
other work has been done by IT professionals contracted just for
the Y2K work.
Mr. UPTON. Okay, well, I appreciate, we all appreciate your testi-
mony this morning. And I would like to think that none of us need
to hold our breath very long, coming up to December 31st. We ap-
preciate all of your work on this and certainly your appearance
today, and we will move to panel two. Thank you very much.
Our second panel will include Mr. James Benson, Executive Vice
President for Technology and Regulatory Affairs of the Health In-
dustry Manufacturers; Mr. Bruce Horowitz, Director of Product As-
surance, representing the Medical Device Manufacturers Associa-
tion; and Mr. Thomas Neill, Vice President of Corporate Services
of Quorum Health Group, representing the American Federation of
Health Systems.
As you heard from the first panel, we have a long tradition of
taking testimony under oath. Do any of you have objection to that?
[Witnesses respond in the negative.]
Mr. UPTON. And under House and committee rules, you have the
right to have counsel with you. Do any of you desire to have coun-
sel?
[Witnesses respond in the negative.]
Mr. UPTON. If you would stand and raise your right hand. Do you
swear to tell the truth, the whole truth and nothing but the truth,
so help you God?
[Witnesses respond in the affirmative.]
Mr. UPTON. You are now under oath. And Mr. Benson, as you
also heard, your testimony is made part of the record in its en-
tirety. We had pretty good compliance with the 5 minute rule with
this little clock, and if you could continue that, we would appreciate
it. Thank you.

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48
TESTIMONY OF JAMES S. BENSON, EXECUTIVE VICE PRESI-
DENT FOR TECHNOLOGY AND REGULATORY AFFAIRS,
HEALTH INDUSTRY MANUFACTURERS ASSOCIATION; AC-
COMPANIED BY BERNIE LIEBLER, DIRECTOR, TECHNOLOGY
AND REGULATORY AFFAIRS; BRUCE HOROWITZ, DIRECTOR
OF PRODUCT ASSURANCE, ADVANCED NEUROMODULATION
SYSTEMS, INC.; AND C. THOMAS NEILL, VICE PRESIDENT OF
CORPORATE SERVICES, QUORUM HEALTH GROUP
Mr. BENSON. Thank you. I shall.
Mr. Chairman, or I should say, chairmen, and members of the
committee, I am Jim Benson, and I am with the Health Industry
Manufacturers Association. We represent more than 800 compa-
nies, accounting for nearly 90 percent of the medical device sales
in the U.S.
I am here today to tell you about the medical device industrys
readiness to function effectively into year 2000. But before I begin,
I would like to introduce my colleague, Bernie Liebler. Bernie has
been responsible for coordinating HIMAs Y2K efforts.
I want to say clearly that the medical device industry views Y2K
as a serious patient safety issue. The industry has invested signifi-
cant resources assuring that its products will function safely. We
are confident when we look back on New Years Day 2000, medical
devices will have provided their usual high standard of reliability
and service.
FDA has just reported the results of their study in which they
reviewed company processes for evaluating product Y2K compli-
ance. The participating HIMA members viewed the study as a val-
uable third party assessment of their work. We believe this pro-
gram demonstrated that the device industry has taken effective ac-
tion on Y2K and that the industry and FDA will work cooperatively
to ensure the safety of products and patients into 2000 and beyond.
Over the past year, I have developed a great appreciation for the
depth and scope of the various company efforts to address the Y2K
issue and avert any problems in both products and operations. In
mid-summer, HIMA published a member survey that reflects this
dedication. All of the companies in our analyzed sample predicted
that their products, production systems and supply chain systems
would be ready by year-end. The total annual domestic revenues of
these companies was $47 billion, while the total domestic revenue
was about $60 billion.
They predicted an aggregate Y2K investment of $700 million.
The members of the industry understand their obligation to protect
patient safety. The device manufacturers goal is to enhance pa-
tient care. Y2K is a unique event, but the industry has addressed
it with the same directness and dedication that it applies to all pa-
tient safety issues.
I want to take a moment and highlight some actions that HIMA
has taken, along with its member companies to assure Y2K readi-
ness. This summer we worked on and distributed the Y2K guide
that the Oden Group prepared for a coalition of health care related
organizations, and we will leave a copy with you of that. We also
worked actively to plan the White House roundtable on consumable
medical surgical supplies, held in early June, and to develop the

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roundtable final statement issued by the Presidents Council on


Y2K Conversion.
Following the roundtable, HIMA published its own position
paper, recommending the same business as usual approach to year-
end purchasing. The industry built its current state of readiness on
a strong foundation of company participation. HIMA worked closely
with FDA and the National Patient Safety Partnership to make the
FDAs Y2K web site the principal collection point for year 2000 de-
vice compliance information.
We urge medical device companies to provide requested Y2K sta-
tus information, co-sponsor ads in prominent trade magazines and
held continuing conversations with FDA and others aimed at mak-
ing the FDA clearinghouse as useful as possible.
Before I conclude, I want to compliment FDA on their fairness
and openness regarding Y2K. In particular, I want to acknowledge
Dr. Tom Shope, of CDRH, whose work has been critical to the suc-
cess of these efforts. I have tried to provide you with a current pic-
ture of the device industrys Y2K readiness, which is based not only
on the work of HIMA companies, and the device industry as a
whole, but on the work of many other groups from Government and
the private sectors.
This industrys primary efforts have been directed at maintaining
patient safety. We are confident that as we enter year 2000, events
will show that we have succeeded. In the meantime, we commit to
continue to work cooperatively with all parties to ensure that the
transition from 1999 to 2000 is safe and uneventful.
[The prepared statement of James S. Benson follows:]
PREPARED STATEMENT OF JAMES S. BENSON, EXECUTIVE VICE PRESIDENT, TECH-
NOLOGY & REGULATORY AFFAIRS, HEALTH INDUSTRY MANUFACTURERS ASSOCIA-
TION

My name is James S. Benson, Executive Vice President, Technology & Regulatory


Affairs for the Health Industry Manufacturers Association. HIMA is a Washington,
D.C.-based trade association that represents more than 800 manufacturers of med-
ical devices, diagnostic products, and medical information systems. HIMAs mem-
bers manufacture nearly 90 percent of the $62 billion in health care technology
products purchased annually in the United States and more than 50 percent of the
$147 billion purchased annually around the world. As such, HIMA is the largest
medical technology trade association in the world. I am pleased to have this oppor-
tunity to tell you about the medical device industrys Y2k readiness to function ef-
fectively into year 2000, most frequently referred to as Y2k, and HIMAs efforts to
both ensure and support that readiness.
Before I continue, I would like to introduce my colleague, Bernie Liebler, HIMAs
Director, Technology & Regulatory Affairs. Mr. Liebler has been responsible for co-
ordinating HIMAs efforts regarding Y2k, and he is here with me to provide his ex-
pertise in responding to questions that you may pose.
I plan now to review what we believe are some of the industrys more significant
activities. Before I begin, I want to say clearly that the medical device industry
views Y2k as a very serious patient safety issue. The industry has invested a great
deal of resources to assure that its products will function safely into year 2000 and
that the industry will be able to continue to deliver vital products as the year
changes. We are confident that when we look back on the change from 1999 to 2000,
medical devices will have provided their usual high standard of reliability and serv-
ice.
In this context, I would like to add that I believe that HIMAs members have done
a fine job of responding to the public needs surrounding the Y2k issue over the past
year and a half. In 1998, its members formed a working group to address both the
strategic and technical aspects of the Y2k issue. Keith Brauer, Vice President and
Chief Financial Officer, Guidant Corporation, has provided excellent leadership as
the Chair of the Working Group with the active participation of many HIMA mem-

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50
ber companies. In my testimony today, I will reference for you some of the activities
that the group has undertaken.
CURRENT STATUS

Voluntary Y2k Program Examinations


The most recent major activity relating to the device industrys readiness is the
Food and Drug Administrations (FDAs) Y2k review project that examined the Y2k
programs of a significant sample of medical device manufacturers. FDA undertook
this project as a means of allaying the concerns regarding medical device readiness
that the General Accounting Office expressed at a hearing this Committee held in
May. To perform the study, they hired Battelle Laboratories, a highly reputed con-
sulting firm with documented skills in the software area. The Battelle representa-
tives examined the processes employed by the manufacturers to determine whether
a device was Y2k compliant, and for those devices determined to be non-compliant,
the processes used to make them compliant.
We expect FDA to describe the results of these examinations in todays testimony.
It is our understanding that the testimony will confirm that the medical device in-
dustry has done a proper job in evaluating its devices and modifying those that re-
quired it. We have spoken with several of the HIMA members that participated in
this voluntary program. Each of them described the visit as professional and non-
confrontational. Overall they believed that the visits were a valuable third-party as-
sessment of work in which they had invested considerable resources. Needless to
say, they were gratified that the evaluations of their work were positive.
Let me describe the role HIMA played in this activity. The Association sees one
of its major roles as ensuring patient safety. HIMA decided that for the Y2k issue,
this was best accomplished by ensuring that its members and, in fact, the entire
medical device industry, were aware of their responsibilities related to the issue and
aware of relevant activities both in the government and in the private sector. When
we were told of FDAs plans to pursue this program, our president, Pamela Bailey,
wrote to all HIMA members both to inform them of the program and to encourage
them to participate in it, if requested by the agency. We followed up that letter by
initiating and coordinating a joint letter from HIMA and other trade associations
to each of the companies in FDAs initial sample selection, urging them to cooperate
with the request to permit the voluntary examination of their Y2k systems. (We
have attached copies of these documents to this testimony.)
Over the past year I have developed a great appreciation for the depth and scope
of the various company efforts to ensure that they have completely addressed the
Y2k issue and averted any problems in both products and operations. The larger
companies have all established dedicated Y2k teams charged with handling all as-
pects of this issue. The member company teams have been in contact continuously
with their vendors, customers, and service suppliers (e.g., utilities, etc.), and with
their trade associations and relevant governmental bodies.
Many went beyond simple correspondence to scheduling in-person visits with their
customers and suppliers and hosting broad-based meetings with multiple constitu-
encies to ensure that all aspects of Y2k were being properly addressed. They have
also been generous with their time and resources in supporting HIMAs activities.
We believe that the successful completion of this program and the positive results
it generated demonstrate several critical facts:
The medical device industry has taken effective action on the Y2k issue.
The industry and the FDA have worked cooperatively to ensure the safety of prod-
ucts and patients into 2000.
The level of concern over the safety of biomedical equipment is now low.
HIMA Y2k Readiness Survey
I would now like to move a bit further back in time to mid-summer, when we pub-
lished the results of a survey of the Y2k readiness of our members. The survey
found that the companies that sell the vast majority of medical devices sold in the
U.S. expect to be Y2k compliant with respect to both their products and their oper-
ations. It also produced several other salient results.
The total revenues of the companies in the analyzed sample were $47 billion; total
domestic sales of medical devices were approximately $60 billion.
90% of the companies predicted that their products would be compliant by the end
of September. The remaining 10% predicted total product readiness by year-end.
Almost 70% expected to complete operations planning by the end of September;
the remainder expected to finish through the fourth quarter.

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51
75% expected to complete both manufacturing and supply chain contingency plans
by the end of September with the remainder finishing during the remaining
three months of the year.
The companies anticipated spending an aggregate total of $700 million by the end
of 1999.
The members of the industry understand fully their obligation to protect the safe-
ty of the patients they serve. The goal of medical device manufacturers is to en-
hance medical care. Thus, ensuring Y2k readiness has been, and continues to be,
an integral part of the industry mission.
Besides the industry survey, there were a number of important milestones this
summer. HIMA also contributed to the completion of the Health Care & Y2k Per-
sonal Planning Guide. This document was developed by the Odin Group under the
direction of a coordinating group comprising a spectrum of health care-related orga-
nizations including medical device companies, insurance carriers, pharmaceutical
companies, trade associations, and others. Several HIMA members also individually
supported this work. The guide contains clear, common-sense recommendations for
consumers on how to approach health care issues as they relate to personal plan-
ning for Y2k. HIMA endorsed the guidance and distributed copies of the booklet to
all of its member companies with suggestions on how they could use it.
HIMA also represented its membership in working with the American Hospital
Association and others in developing the final statement that was issued by the
Presidents Council on Year 2000 Conversion, and signed by its chairman, John
Koskinen, and Kevin Thurm, Assistant Secretary of the Department of Health and
Human Services. The statement distilled the results of the Presidents Council on
Year 2000 Roundtable, Consumable Medical and Surgical Supplies held in early
June. The statement reflected the meeting consensus that hoarding or stockpiling
of medical supplies is fundamentally counterproductive and recommended following
historical ordering patterns based on current needs. We devoted significant time to
planning this meeting, and two company representatives were speakers at the meet-
ing. We believe this very useful activity once again demonstrated the cooperative
relationship between the government and private sectors that has characterized our
experience with the Y2k issue.
As a result of the Roundtable, HIMA developed and issued its own position paper,
Ensuring Patient AccessHIMA Position on Preparing for Y2k, which also rec-
ommends a business as usual approach to year-end purchasing of consumable
medical/surgical supplies. (We have attached a copy of this document to this testi-
mony.)
OTHER Y2K ACTIVITIES

I have just described to our most recent information on the industrys readiness
and some of the ways in which HIMA worked to support industrys efforts. All of
HIMAs work was built on a strong foundation of member participation that began
in 1998.
Effective Industry Communications
As I mentioned earlier, HIMA sees one of its roles on this issue as a provider of
information in support of industry activities. HIMA used its Internet site,
HIMAnet.com, to provide relevant information to the entire industry. To accomplish
this, we created a special section on the site devoted entirely to Year 2000 issues.
We have used this Y2k area to publicize the events in which we have participated
and to promote industry participation in and cooperation with a variety of govern-
ment activities. These have included the FDAs Federal Y2k Biomedical Information
Clearinghouse, the Presidents Council on Year 2000 Roundtable, Consumable Med-
ical and Surgical Supplies, which I just discussed, and the Community Conversa-
tions suggested by John Koskinen. Although the Community Conversations were
aimed primarily at providing information to the public regarding local facilities and
services, we recommended that medical device companies participate. We have also
published a steady stream of articles in our newsletter, In Brief, reaching almost
10,000 readers in all parts of the medical device industry, including senior execu-
tives and the press.
In August 1998, HIMA formed its Year 2000 Issue Working Group. This Working
Groups first task was to develop working relationships with the National Patient
Safety Partnership, the FDA, and any groups concerned with the Y2k readiness of
electronic medical devices. The working group reached out to the Partnership, an
important coalition comprising the Department of Veterans Affairs, the American
Hospital Association, the American Nurses Association, and the American Medical
Association, among others. The Partnership proposed the development of a central
clearinghouse on the compliance status of medical technology.

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HIMA worked diligently and closely with FDA and the Department of Veterans
Affairs to help the FDAs Federal Y2k Biomedical Equipment Clearinghouse (Clear-
inghouse) become the principal central collection point for Year 2000 device compli-
ance information. The initial focus of the FDA Clearinghouse effort was to gather
information on non-compliant devices. In support of that critically important goal,
HIMA:
Encouraged the industry to respond to FDAs requests for information for the
Clearinghouse, resulting in a 100-percent response rate from HIMA member
companies.
Communicated with more than 6,000, primarily small, non-member companies in
the industry urging them to respond to the FDA request for Year 2000 status
information and to ensure that their devices are Year 2000 compliant.
Sponsored advertisements with the FDA, the Department of Veterans Affairs,
and other industry associations in key trade magazines urging device companies
to respond to FDAs request for Year 2000 status information.
In addition, HIMA worked to ensure the effectiveness of communications with our
own member companies by:
Asking each member company to designate the individual responsible for coordi-
nating Year 2000 activities.
Working with the FDA and the VA to ensure that their communications were
reaching the right people, especially in instances where they were receiving no
response.
Making calls to non-member companies who had failed to respond to the VA and
FDA requests for Year 2000 information to urge them to post their compliance
information on FDAs Federal Y2k Biomedical Equipment Clearinghouse.
Federal Y2k Biomedical Equipment Clearinghouse
After the initial cooperative efforts to make the Clearinghouse an effective tool for
providing information on non-compliant devices, HIMA and the Partnership made
further recommendations to improve it. For example, there have over the years been
many mergers and acquisitions within the medical device industry. This changing
business landscape makes it difficult in some cases to trace the provenance of some
devices. One of the joint recommendations was for device manufacturers to provide
more information to the clearinghouse on company and device histories to assist de-
vice owners in locating information for older devices.
After the Clearinghouse was working effectively to provide information on non-
compliant devices, FDA expanded its content to include information on Year 2000
compliant devices. This provided one stop shopping for health care providers on
compliance information. HIMA worked closely with the FDA to help develop a tem-
plate to facilitate a better industry response. We also strongly encouraged our mem-
bers to respond to this new FDA request for information. HIMAs President urged
all HIMA members to provide the requested information. HIMA also used its Web
site to promote compliance with the request.
I want to take a moment now to compliment FDA on the way they have conducted
their Y2k operations. They have been extremely fair and have welcomed industry
assistance and cooperation. I want particularly to acknowledge the work of Dr.
Thomas Shope of the Office of Science and Technology at the Center for Devices and
Radiological Health, whose work with the industry has been both helpful and pro-
fessional. We are pleased to have been able to work with him so productively on
this issue.
CONCLUSION

What I have tried to do is provide the Committee with a current picture of the
medical device industrys Y2k readiness. This current level of readiness is based not
only on the work of HIMA companies and the device industry as a whole, but also
on many other groups from the government and private sectors. Both HIMA staff
and members have had very positive experiences working with many dedicated em-
ployees of the Federal agencies involved in monitoring the Y2k issue. In the final
analysis, these have been highly cooperative and very productive and have resulted
in broad expectations that medical devices will function safely as we enter year
2000.
This industrys primary efforts have been directed at maintaining patient safety
and high quality. We are confident that as we enter year 2000, events will show
that we have been successful. In the meantime, the medical device industry commits
to continue working cooperatively with all parties to ensure that the transition form
1999 to 2000 is safe and uneventful.

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Mr. UPTON. Thank you.


Mr. Horowitz?
TESTIMONY OF BRUCE HOROWITZ
Mr. HOROWITZ. Good morning, chairmen and subcommittee mem-
bers.
I am Bruce Horowitz, Director of Product Assurance for Ad-
vanced Neuromodulation Systems, Inc., of Plano, Texas. I appear
before you today on behalf of the 130 members of the Medical De-
vice Manufacturers Association. Thank you for this opportunity to
tell you how our industry has responded to the year 2000 computer
date problem.
MDMA is the national voice for the entrepreneurial sector of the
medical device industry. The association as established in 1992 by
a group of executives of small and mid-sized companies who be-
lieved that medical technology and entrepreneurs need distinct rep-
resentation before the Federal Government.
As in most industries, small and startup companies have dif-
ferent perspectives and needs than their larger counterparts. This
is particularly true in highly regulated industries such as ours.
MDMA appreciates the attention paid by your subcommittees to
the year 2000 computer date problem.
On behalf of the 300,000 employees of the American medical
technology industry, I am pleased to tell you that we are ready for
the calendar to turn on January 1. In my written testimony, I have
outlined several reasons why the public should rest assured that
the turn of the millennium will be business as usual for medical
devices. The very nature of our industry, in fact, mitigates the po-
tential impact of the Y2K problem.
Since the pace of innovation in our industry is so rapid, most
medical devices have very short life on the market, before compa-
nies and their competitors introduce a next generation of product.
Many of the current generations of products on the market, there-
fore, were introduced during a time when engineers and computer
programmers were well aware of the Y2K problem and its signifi-
cance.
Here is how our company dealt with the Y2K problem. ANS de-
velops and markets implantable medical devices for the
neuromodulation market. Neuromodulation is the electrical or
chemical stimulation of the central nervous system to reduce pain
or improve neurologic function. Our products include implantable
spinal cord stimulation systems to manage chronic, intractable
pain. The FDA has identified this device as potentially high-risk.
We at ANS had already assessed that our devices were Y2K com-
pliant, even before the FDA announced in January its intent to ex-
pand the information maintained in the Y2K clearinghouse. How-
ever, we recognized the importance of publicly assuring our cus-
tomers and patients that our products would not be affected by the
Y2K problem. Therefore, our senior management approved a pro-
gram to expand the Y2K compliance program. This program was
based primarily on guidelines provided by the U.S. General Ac-
counting Office and the British Standards Institute.
At ANS, we assessed our in-house equipment, evaluated our de-
vices, and notified our customers that we are Y2K compliant, and

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54

that our product and service sources had addressed any potential
problems. In my written statement, you will see the specific steps
ANS took to deal with the various aspects of Y2K readiness and
disclosure.
To inform our customers, the most important people in this equa-
tion, we composed a letter that summarized the Y2K status of our
products in the field. We decided to respond to customer inquiries
in this way, since we literally had hundreds of inquiries on this
subject, some of them containing multiple page surveys.
As a small company, we did not have the resources to fill out
these surveys, so we determined that a summary letter would be
the best and most appropriate solution. So far, all of our customers
have indicated that the letter met their needs.
We have also responded promptly to all FDA requests for infor-
mation. So far in 1999, we have provided data on our products four
times.
While at ANS we will not consider our Y2K compliance program
to be complete until we have processed our last customer request
for information, we were able to complete the actual assurance of
Y2K compliance throughout all phases in April. We at ANS have
worked with MDMA over the last 2 years to help the medical tech-
nology address Y2K concerns. You should know that MDMA has
collected information from its members for inclusion in the FDAs
database, published public service announcements, worked with
the FDA to redefine their Y2K surveys and databases, and helped
develop industry-wide guidelines to assure the smooth operation of
the health care supply chain during the Y2K transition period.
Nevertheless, we are concerned that the health care providers
are not using the resources available to them to find out informa-
tion on the Y2K status of biomedical equipment. Furthermore, we
are concerned that providers may be conducting unnecessary tests
of biomedical equipment that may create problems where none
would otherwise exist.
MDMA respectfully disagrees with the OIGs recommendation
that testing is the only way to ensure device functionality. Instead,
MDMA encourages providers to heed the advice of the well-re-
spected Emergency Care Research Institute, that testing when
complete compliance information is available is not necessary.
ECRI has received only a few confirmed reports of hospital tests
that contradict manufacturers statements. And in none of these in-
stances was the essential functionality of the device an issue.
Furthermore, ECRI rightly points out that problems could be in-
troduced during the testing of a device. MDMA is confident that
the safety, effectiveness, performance and reliability of medical
technology will be largely unaffected by the Y2K computer date
program. However, to ensure as smooth a Y2K transition as pos-
sible, MDMA encourages health facilities and professionals to con-
sult the FDAs Y2K clearinghouse and to contact manufacturers for
more detailed information if necessary, to refrain from unnecessary
testing of biomedical equipment when complete compliance infor-
mation is available, and to preserve the integrity of the supply
chain by not hoarding or stockpiling medical supplies and equip-
ment.
Thank you again for this opportunity to appear before you.

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55

[The prepared statement of Bruce Horowitz follows:]


PREPARED STATEMENT OF THE MEDICAL DEVICE MANUFACTURERS ASSOCIATION
Good morning, chairmen and subcommittee members. I am Bruce Horowitz, direc-
tor of product assurance for Advanced Neuromodulation Systems, Inc. (ANS), lo-
cated in Allen, Texas. I appear before you today on behalf of the 130 members of
the Medical Device Manufacturers Association (MDMA). Thank you for this oppor-
tunity to tell you how my company and the medical device industry have responded
to the Year 2000 computer-date problem.
MDMA is the national voice for the entrepreneurial sector of the medical device
industry. The association was established in 1992 by a group of executives of small
and mid-sized companies who believed that medical technology entrepreneurs need-
ed distinct representation before the federal government. As in most industries,
small and start-up companies have different perspectives and needs than their larg-
er counterparts, and this is particularly true in highly regulated industries such as
ours. For our part, we at ANS are proud to be one of the founding members of
MDMA.
MDMA appreciates the attention paid by your subcommittees to the Year 2000
computer-date problem. The 300,000 people employed in the medical device industry
share your concern about the possible effects that Year 2000 or Y2K malfunctions
could have on patient safety. I am pleased to tell you, however, that the medical
technology industry is ready for the calendar to turn on January 1.
Significance and Potential Impact of the Y2K Computer-Date Problem
The nature of the Y2K problem has been documented at previous hearings and
by previous witnesses today, so I wont add to the technical description. I will say,
however, that we recognize the significance of the problem for certain medical device
manufacturers and the potential impact on patient safety that the Y2K problem
could have if not addressed properly.
As businesses, medical device manufacturers have numerous business-related rea-
sons for wanting to address and fix any potential Y2K problems with our products.
However, as businesses involved in healthcare, we also have a public-health respon-
sibility to prevent Y2K problems from harming patients. Clearly, it is not in our
best interests as businesses or as responsible members of the healthcare community
to neglect the Y2K situation.
There are other reasons for the public to rest assured that the turn of the
millenium will be business as usual for medical devices. Under the FDAs quality
systems regulation, medical device manufacturers must ensure that our production
processes and other computerized processes function properly and will not be dis-
rupted by any Y2K problems. The FDA has enforced this regulation fairly, and we
are pleased to hear the agency publicly state that the Y2K problem will not have
a major effect on medical technology. The subcommittees also should note that while
many medical device manufacturers depend on computer hardware and software for
their products to function or to enable production, very few devices depend critically
on date-related information to function properly.
The very nature of our industry also mitigates the potential impact of the Y2K
problem. Since the pace of innovation in our industry is so rapid, most medical de-
vices have a very short life on the market before companies and their competitors
introduce a next generation of products. Many of the current generations of products
on the market, therefore, were introduced during a time when engineers and com-
puter programmers were well aware of the Y2K problem and its significance.
How ANS Addressed the Y2K Problem
Heres how our company dealt with the Y2K problem. ANS develops and markets
implantable medical devices for the neuromodulation market. Neuromodulation is
the electrical or chemical stimulation of the central nervous system to reduce pain
or improve neurologic function. Our products include implantable spinal cord stimu-
lation systems to manage chronic intractable pain. We are also developing an
implantable pulse generator and an implantable drug administration system, both
of which will be used in the management of chronic pain and nervous system dis-
orders.
We at ANS had already assessed that our devices were Y2K-compliant, even be-
fore the FDA announced in January its intent to expand the information maintained
in its Federal Y2K Biomedical Equipment Clearinghouse [www.fda.gov/cdrh/yr2000/
year2000.html], the main centralized information source on the Y2K status of bio-
medical equipment. However, we recognized the importance of publicly assuring our
customers and patients that our products would not be affected by the Y2K problem.

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56
Therefore, our senior management approved a program to expand our Y2K compli-
ance program. This program was based on guidelines provided by the General Ac-
counting Office in a document called Year 2000 Computing Crisis: An Assessment
Guide. We also relied upon DISC PD2000-1, A definition of Year 2000 Conformity
Requirement, published by the British Standards Institute (BSI).
At ANS, we assessed our in-house equipment, evaluated our devices, and notified
our customers that we are Y2K-compliant and that our product and service sources
had addressed any potential problems. The four key elements of this Y2K compli-
ance program were general integrity, date integrity, explicit/implicit century and
leap year.
Here are the specific steps ANS took to deal with the various aspects of Y2K read-
iness and disclosure:
Computer systemsWe tested all hardware and software or assured that our sup-
plier had certified to Y2K compliance. Our tests and assurance included all com-
puter systems and key software, such as our operating systems, our manufac-
turing management systems, and our quality management software.
ProductsWe assured that all of our computerized or microprocessor-based prod-
ucts had been tested or evaluated according to the conformity requirements con-
tained in the BSI document. This encompassed the transmitter, the receiver
and the programmer in our devices.
Manufacturing equipment and test equipmentWe assured that all computer-
ized or microprocessor-based equipment in manufacturing or testing had either
been tested or certified to Y2K compliance by its maker.
SuppliersWe queried our suppliers of products and services as to their Y2K read-
iness. At this point, we have assured that all key suppliers will be in compli-
ance by December 31 or have contingency plans to ensure an uninterrupted
supply of components.
CustomersWe composed a letter to our customers that summarized the Y2K sta-
tus of our products in the field. We decided to respond to customer inquiries
in this way since we literally had hundreds of inquiries on this subject, some
of them containing multiple-page surveys. As a small company, we did not have
the resources to fill out these surveys, so we determined that a summary letter
would be the best and most appropriate solution. So far, all of our customers
have indicated that the letter met their needs.
FDAWe have responded promptly to all FDA requests for information. So far in
1999, we have provided data on our products four times, in January, March,
June and September.
Ongoing ActivitiesWe continue to require and evaluate information regarding
Y2K compliance for any new products, equipment or suppliers.
While we at ANS will not consider our Y2K compliance program to be complete
until we have processed our last customer request for information, we were able to
complete the actual assurance of Y2K compliance throughout all phases in April.
The Industry Perspective
MDMA is pleased to know that the FDA believes the medical technology industry
is well prepared for the year 2000. MDMA has worked with its members and the
FDA over the past two years to help the medical technology industry address Y2K
concerns. For instance, MDMA has
collected information from its members for inclusion in the FDAs Federal Y2K
Biomedical Equipment Database;
joined with fellow associations in publishing public-service announcements in
trade publications to raise general industry awareness;
worked with the FDA, hospitals, distributors, and other stakeholders to refine
Y2K surveys and databases to improve the quality of Y2K information available
to patients and users; and
helped develop industry-wide guidelines to assure health facilities and profes-
sionals of a continual and reliable supply and availability of medical products
throughout the Y2K transition period.
Nevertheless, we are concerned that hospitals, other health facilities, and health
professionals are not using the resources available to them to find out information
on the Y2K status of biomedical equipment. Furthermore, we are concerned that
these same organizations and individuals may be conducting unnecessary testing of
biomedical equipment that may create problems where none would otherwise exist.
The recent survey by the Office of the Inspector General (OIG) at the Department
of Health and Human Services suggests that end-users are not taking advantage
of the Federal Y2K Biomedical Equipment Database. While we are heartened to see
that nearly every hospital responding to the survey believes that their biomedical
equipment will be Y2K-ready by December 31, we are disappointed that only 79 per-

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57
cent were aware of the FDAs database, and only 59 percent had visited the data-
base for information about the Y2K status of their equipment. I hope that the FDA,
the hospital associations, and other representatives of health facilities and profes-
sionals will redouble their efforts to inform the healthcare community about the
FDAs Y2K clearinghouse.
The OIGs survey also found that 68 percent of hospitals have tested their bio-
medical equipment to verify Y2K readiness. MDMA is concerned that in many cases,
this testing is not necessary and may cause problems with the equipment being test-
ed.
An independent health services research agency, the Emergency Care Research
Institute (ECRI), in its Position Statement on the Testing of Medical Devices for
Year 2000 Compliance, writes that testing when complete compliance information
is available is not necessary for a variety of reasons. For example, ECRI believes
that healthcare facilities are not likely to have the expertise, the access, and the
resources to perform testing at the level needed to provide a reasonable assurance
that a device is compliant. ECRI also has received only a few confirmed reports
of hospital tests that contradict manufacturer compliance statements, and all these
reports have involved minor problems such as devices displaying or printing incor-
rect date information. Finally, ECRI points out that problems could be introduced
during testing of a device.
MDMA agrees with ECRIs findings and urges health facilities and professionals
to consult the FDAs information clearinghouse and to contact manufacturers before
conducting any further Y2K testing of biomedical equipment.
Summary
MDMA is confident that the safety, effectiveness, performance, and reliability of
medical technology will be largely unaffected by the Y2K computer-date problem.
This is a direct testament to the focus and commitment of Advanced
Neuromodulation Systems and our colleagues in the more than 7,000 companies in
the medical device industry, more than two-thirds of which have fewer than 50 em-
ployees. To ensure as smooth a Y2K transition as possible, MDMA encourages
health facilities and professionals
to consult the FDAs Y2K clearinghouse and to contact manufacturers for more
detailed information if necessary;
to refrain from unnecessary testing of biomedical equipment when complete com-
pliance information is available; and
to preserve the integrity of the supply chain by not hoarding or stockpiling med-
ical supplies and equipment.
Finally, MDMA commends the FDA for its efforts to provide health facilities and
professionals with the resources they need to certify the Y2K compliance of their
biomedical equipment. We also commend your subcommittees for your reasoned and
even-keeled oversight of this situation. Thank you again for this opportunity to ap-
pear before you.
Mr. UPTON. Mr. Neill?

TESTIMONY OF C. THOMAS NEILL


Mr. NEILL. Good morning, Mr. Chairman and members of the
committee.
I am Tom Neill, Vice President, Corporate Services, of Quorum
Health Group. During the past several years, I have served as the
executive sponsor for our company-wide Y2K program. I am hon-
ored to appear before you today on behalf of my company, which
is a member of the Federation of American Health Systems, and
on behalf of the hospital industry.
Today I will discuss Quorums activities and preparations con-
cerning Y2K which are expected to cost approximately $20 million.
Quorum Health Group, through its affiliates, operates acute care
hospitals and health systems nationwide. Through its affiliates,
Quorum currently owns 21 hospitals, manages 223 hospitals, pro-
vides consulting services to 122 facilities and has more than 20,000
employees in more than 40 States and the District of Columbia.

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Through great effort and a significant commitment of time, re-


sources and money, we are pleased to say that over 98 percent of
our Tier 1 clinical equipment at our own hospitals has been as-
sessed and remediated for Y2K readiness. While our primary focus
has been on equipment and systems that affect our ability to con-
tinue to deliver quality patient care, we recognized early on that
a complete program involves addressing all aspects of the operation
of a hospital.
In 1997, we began educating the hospital base chief information
officers of our own hospitals about the year 2000 issue. They subse-
quently began working with their primary vendors that developed
and supported our core information systems. In July 1998, the com-
pany hired outside consultants to form a program management of-
fice to assist our own hospitals even further in their preparations
for the year 2000.
We have adopted a three tier approach for Y2K project comple-
tion. For instance, Tier 1 addresses applications and equipment
that have a direct impact on patient safety and health care, or are
essential to our daily operations. We are also using an outside ven-
dors database to gather and monitor manufacturer year 2000 com-
pliance information for biomedical devices, building infrastructure
components and information technology systems.
Our own hospitals year 2000 strategy includes phases for edu-
cation, inventory and assessment, validation and conversion, and
remediation or replacement. We are also developing contingency
plans to address potential disruption of operations arising from the
year 2000 problem. Quorum estimates that it will spend approxi-
mately $20 million on Y2K activities for its 21 own hospitals.
Simply put, our policy is, we will not deploy any Tier 1 bio-
medical device for patient care without reasonable assurance that
it will perform properly in light of the year 2000 problem. Quorum
has substantially completed testing and validation of all Tier 1 bio-
medical equipment. We have not tested devices where the manufac-
turer has advised us against testing such equipment, and rep-
resented year 2000 compliance in writing. We currently expect to
complete remediation of the remaining 2 percent or approximately
400 items by the end of 1999.
To restate, our policy is that we will not deploy any Tier 1 bio-
medical device for patient care without reasonable assurance that
it will perform properly in light of the year 2000 problem. Further,
our policy is to test all equipment that we have identified as Tier
1 regardless of the manufacturers stated Y2K status.
While Quorum has taken a very conservative approach to testing
all Tier 1 biomedical equipment, even those that the manufacturer
states is compliant, responsibility of compliance still remains with
the equipment manufacturer. Despite our best efforts, we are un-
able to test to the same degree that a manufacturer of that device
could test.
Each of our hospitals disaster plans form the foundation for our
year 2000 contingency planning, but we have gone beyond this.
Quorums Y2K contingency planning training has been performed
and best practices reviewed and shared with all hospitals. In fact,
Y2K drills are being conducted now with a company-wide drill
planned for November.

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In conclusion, the comprehensive approach that we have taken


on Y2K demonstrates the level of Quorums commitment to the de-
livery of quality patient care in our hospitals. The approach to test-
ing all Tier 1 biomedical equipment, coupled with our commitment
to restrict the use of any device that is not Y2K ready, increases
our confidence that patient safety and quality care will not be com-
promised in our hospitals.
To address the year 2000 issue to this degree has required a sig-
nificant amount of resources, from our hospitals and business part-
ners alike. However, Quorum is committed to working with our
business partners and communities to ensure a safe transition into
the next millennium.
Thank you for this opportunity to testify before you today, Mr.
Chairman, and I welcome your questions.
[The prepared statement of C. Thomas Neill follows:]
PREPARED STATEMENT OF C. THOMAS NEILL, VICE PRESIDENT, CORPORATE
SERVICESQUORUM HEALTH GROUP, INC. ON BEHALF OF THE FEDERATION OF AMER-
ICAN HEALTH SYSTEMS

INTRODUCTION:

Good morning Mr. Chairman and Members of the Committees. I am Tom Neill,
Vice President, Corporate Services, of Quorum Health Group, Inc. During the past
several years, I have served as the executive sponsor for our company-wide Y2K pro-
gram. I am pleased to appear before you today on behalf of my company, which is
a member of the Federation of American Health Systems, and on behalf of the hos-
pital industry. The Federation of American Health Systems represents nearly 1,700
privately owned and managed community-based hospitals and health systems that
offer traditional acute care, ambulatory care, rehabilitative care, and allied compa-
nies involved in health care systems.
For purposes of todays hearing, I will discuss Quorums activities and prepara-
tions concerning Y2K, which are expected to cost more than $20 million. Quorum
Health Group, Inc., through its affiliates, operates acute care hospitals and health
systems nationwide. Through its affiliates, Quorum currently owns 21 hospitals,
manages 223 hospitals, provides consulting services to 122 facilities and has more
than 20,000 employees in more than 40 states and the District of Columbia.
Year 2000 Plan
Through great effort and a significant commitment of time, resources and money,
we are pleased to say that over ninety-eight percent of our Tier 1 clinical equipment
in our owned hospitals has been assessed and remediated for Y2K readiness. While
our primary focus has been on equipment and systems that affect our ability to con-
tinue to deliver quality patient care, we recognized early on that a complete pro-
gram involves addressing all aspects of the operation of a hospital.
In 1997, we began educating the hospital-based chief information officers (CIOs)
of our owned hospitals about the Year 2000 issue. They subsequently began working
with their primary vendors that developed and supported our core information sys-
tems. In July 1998, the Company hired outside consultants to form a Program Man-
agement Office (PMO) to assist our owned hospitals even further in their prepara-
tions for the Year 2000. The PMOs integrated, team-oriented approach brought to-
gether a team of experienced players into one centralized office. The group included
numerous associates from Quorum, consultants from Keane, the law firm of Rudnick
& Wolfe of Chicago, and third party management service providers who took the
unique project very seriously from day one.
Year 2000 Approach
We have adopted a tier approach for Year 2000 project completion. Tier 1 ad-
dresses applications and equipment that have a direct impact on patient safety and
health or are essential to our daily operations. Tier 2 represents applications and
equipment that are critical to continued business operations, but not required to
provide day-to-day service to the patients and for which a viable alternative exists.
Tier 3 relates to applications and equipment that are not essential to our daily oper-
ations.

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60
To date, we have given first priority in our testing and remediation efforts to Tier
1 applications and equipment. We are also currently validating and remediating
Tier 2 devices, components and systems. We currently expect to substantially com-
plete validation and remediation of Tier 2 devices, components and systems by the
end of 1999. In addition to our own testing, we are using an outside vendors data-
base to gather and monitor manufacturer Year 2000 compliance information for bio-
medical devices, building infrastructure components and information technology sys-
tems. In general, we are relying on vendor verification of Year 2000 compliance for
Tier 2 devices, components and systems, rather than testing these items ourselves.
Process Overview/Phases
The PMO developed a multi-phase approach to help Quorum-owned hospitals
quickly address their Y2K mission critical issues. While not directly a part of the
PMO, hospitals managed by Quorum Health Resources, LLC, have been provided
education and suggested guidelines for their own readiness efforts. Best practices
are shared with managed facilities to assist their independent efforts.
Our owned hospitals Year 2000 strategy includes phases for education, inventory
and assessment, validation (including testing) and conversion, remediation or re-
placement. We are also developing contingency plans to address potential disruption
of operations arising from the Year 2000 problem.
Awareness: This is truly an ongoing function. We are continually raising the
level of awareness and education of the hospitals Y2K projects throughout the Com-
pany and communities.
Inventory: We have taken action to ensure thorough and comprehensive inven-
tory identification.
Assessment and Impact Analysis: We have made a comprehensive assess-
ment of all hospital systems, equipment and vendors, utilizing a tier approach
where priorities are based on impact and criticality.
Testing: Quorums testing strategy for biomedical equipment involves setting
the date to one of four potentially problematic dates (e.g., 1/1/2000, 2/29/2000, etc.).
Quorum has taken a conservative approach by establishing a policy to test all Tier
1 biomedical equipment where feasible.
Remediation: Quorum has undertaken the remediation process and is cor-
recting Y2K problems in biomedical equipment, computer systems, or other hospital
equipment. This action may include replacement, upgrade, elimination, or per-
forming a workaround.
Contingency Planning: Our hospitals are preparing for potential Y2K prob-
lems by first reviewing existing hospital disaster recovery plans, then developing
Year 2000 specific contingency plans.
Documentation: Our hospitals are implementing a process to ensure that the
hospitals Y2K project efforts and activities are properly recorded and well pre-
served.
Costs & Impact
Quorum estimates that it will spend approximately $20 million dollars on Y2K
activities for its 21 owned hospitals. Specifically, the total resources necessary to
manage an inventory of 32,000 devices and systems towards Y2K readiness will cost
approximately four million dollars. Capital costs for replacing, upgrading, and fixing
Y2K issues are estimated to total approximately $16 million dollars of the $20 mil-
lion dollars. This includes replacing the core information systems in six (6) owned
hospitals.
Approximately fifty percent (or 16,000) of Quorums Y2K inventory was given the
highest priority rating of Tier 1 based upon possible impact to patient care and hos-
pital operations. Seventy-five percent, or approximately 12,000 of that 16,000, were
clinical devices. We discovered that approximately forty percent of our clinical de-
vices have no Y2K sensitivity, meaning the device has no clock chip. Therefore, we
tested approximately 7,000 clinical devices in our owned hospitals.
Hospital Medical Device Testing
We have substantially completed testing and validation of all Tier 1 biomedical
equipment. We have not tested devices where the manufacturer has advised us
against testing such equipment and represented Year 2000 compliance in writing.
We believe that approximately ninety-eight percent of the Tier 1 devices requiring
Year 2000 validation are now Year 2000 compliant. We currently expect to complete
remediation of the remaining two percent, or approximately 400 items, by the end
of 1999. Our policy is that we will not deploy any Tier 1 biomedical device
for patient care without reasonable assurance that it will perform properly
in light of the Year 2000 problem. Such assurance may take the form of testing,

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vendor assurances of Year 2000 compliance or, where feasible, developing a work-
around procedure for the device in case of a possible malfunction.
Y2K Readiness Validation
Quorum has taken a dual approach to determining the Y2K readiness of our hos-
pitals medical devices. First and foremost, we look to the manufacturer for the sta-
tus, knowing that they are the ultimate authority on their own equipment. We con-
tracted with an outside service provider to manage and update the compliance sta-
tus from manufacturers. This service provider gathered information from the FDA
web site, manufacturer web sites, or directly from the manufacturer.
Second, our testing program provides additional verification of the information
from the manufacturer. Our policy is to test all equipment which weve identi-
fied as Tier 1, regardless of the manufacturers stated Y2K status. The only
exception to this policy is granted when the vendor provides written assurance that
the device is Y2K compliant and states that field testing would or could damage the
equipment.
Responsibilities
While Quorum has taken a very conservative approach to testing all Tier 1 bio-
medical equipment, even those that the manufacturer states as compliant, responsi-
bility of compliance still remains with the equipment manufacturer. As a user of the
equipment, we believe we can only reasonably perform tests of the rollover from one
date to another. Despite our efforts, we are unable to test to the same degree that
a manufacturer of that device could test.
Contingency Planning
We developed contingency plans in all of our owned hospitals that we believe will
reduce disruption in service that could be caused by the Year 2000 problem. As part
of our contingency plan, each of our owned hospitals has a disaster plan, which we
review regularly. These disaster plans are designed to enable the hospital to con-
tinue to function during natural disasters and other crises. Y2K contingency plan-
ning training has been performed and best practices reviewed and shared with all
hospitals. Minimum standards for the plans were set and a review of every hos-
pitals plan is under way. Y2K drills are being conducted with a company-wide drill
planned for November.
Industry Status Observations
Overall reports from the Department of Health & Human Services indicate that
the majority of hospitals will be ready for the Year 2000. Also, the recent survey
by the American Hospital Association on Y2K Readiness of Fee-For-Service Pro-
viders as of July 1999 made the following points:
Twenty-seven percent of responding hospitals say that ALL their biomedical
equipment is ready. Of those whose biomedical equipment is not ready, the ma-
jority (357) say that they have completed eighty-six percent or more.
Nearly all hospitals (513) predict that ninety-nine percent of their equipment will
be ready by the end of the year.
Another recently released report on the Y2K readiness of healthcare providers
from the Office of Inspector General (OIG) indicates that most hospitals will be
ready for Y2K. As quoted:
Hospitals had the highest survey response rate which shows their willingness to
be forthcoming about the work that is still needed to be completely Y2K ready.
Clearly, the survey indicated that the vast majority of hospitals are doing every-
thing it takes to be Y2K ready.
Conclusion
In conclusion, the comprehensive approach that we have taken on our Year 2000
program demonstrates the level of Quorums commitment to the delivery of quality
patient care in our hospitals. The approach to testing all Tier 1 biomedical equip-
ment, coupled with our commitment to restrict the use of any device that is not Y2K
ready, increases our confidence that patient safety and quality care will not be com-
promised in our hospitals. To address the Year 2000 issue to this degree has re-
quired a significant amount of resources from our hospitals and our business part-
ners alike. However, Quorum is committed to working with our business partners
and communities to insure a safe transition into the next millennium. Thank you
for this opportunity to testify before you today. I welcome your questions.
Mr. UPTON. Weve appreciated the testimony of all of you. As you
have heard from these buzzers and lights, we have a vote on. We

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are going to try to keep the committee moving as we did in the first
panel. Mr. Bryant has gone over, he has the fast legs, so he will
be back soon, and Mr. Brown will be back as well, and obviously
Mr. Bilirakis.
Before I need to go and vote, I have a couple of questions for
sure. The HHS inspector general report indicated that about 60 to
70 percent of providers rely on manufacturers assurances that the
equipment will be Y2K compliant. But about half of the hospitals
apparently reported problems getting information from those man-
ufacturers. Any reason why? Any thoughts between the three of
you?
Mr. NEILL. Mr. Chairman, if I might respond, initially
Mr. UPTON. I mean, it sort of goes back to the series of questions
that I asked, as well, that the manufacturers ought to be the first
ones on the scene to report back to the providers in terms of prob-
lems that they might experience.
Mr. NEILL. I agree with your assessment, Mr. Chairman. Early
on in the Y2K agenda, and when I say early on, 18 months ago,
there was a huge cloud of liability over the entire concept of Y2K.
And that cloud of liability still remains today.
But early on, in response to your question, there was some ap-
prehension on behalf of the manufacturers to come forth and be to-
tally forthright and candid regarding the Y2K compliance of their
equipment. But we have not found that to be the case this year.
The FDA has done a commendable job in pulling that informa-
tion together. Other organizations, such as the VHA out in Dallas,
likewise, working with FDA, has pulled the manufacturers infor-
mation together. And we have found that information to be readily
attainable.
Mr. UPTON. I would just note from my own personal observa-
tions, I have a large employer in my district called Stryker. I know
you recognize it. I know those folks very well. And as I went in,
and kicked the tires, as one might say, I found that their attitude
was very responsible in making sure that everything was compliant
and full notice was given, and a concern to no end to make sure
that literally every rock and stone was unturned just to make sure
that they would not experience problems.
Would you say that in general, most other device manufacturers,
particularly in your membership, Mr. Benson and Mr. Horowitz,
followed the same type of lead that the Stryker folks have?
Mr. BENSON. Absolutely.
Mr. UPTON. Is that indicative of the entire industry?
Mr. BENSON. Absolutely. I think common sense, if you just look
at it from a common sense standpoint, these companies are in busi-
ness to help patients, to make sure patients are treated safely, that
the quality of health care is very positive, the quality of their lives
is very positive.
And of course, there is a profit motive. It does not make sense
for them to not put that information out. I think the example you
gave from Stryker is a good one, and I think that is the model that
companies have followed.
In answer to your question, the only reason I can think of, per-
haps in addition to Mr. Neills explanation, is simply just volume
of requests. I am a little doubtful of that data. I would think that

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if you look back over the past several months, over the past year
or so, that the vast majority of questions have been answered, and
probably answered promptly.
Mr. UPTON. Okay. I am getting a little nervous, I have not
missed a vote this year or last year, and I want to make sure I get
there. I know Mr. Bryant will be back momentarily and we will
continue at that point.
Thank you.
[Brief recess.]
Mr. BRYANT [PRESIDING]. We will reconvene.
I left early and raced over there to vote so I could relay back and
catch the chairman, but we did not quite make the time pass ex-
actly. But in the interest of saving you folks some time, you have
been here a long time, we try to do that occasionally and make it
work.
Mr. HOROWITZ. He complimented your legs.
Mr. BRYANT. I did not have my cape on, I might have flown over
there today.
I understand we are at that point where we have finished our
statements. Mr. Neill, I think you were testifying when I left.
Again, it was nothing you said that caused me to leave.
But let me start the questioning, if I could. I think I wanted to
ask Mr. Neill, I understand perhaps you have conducted some test-
ing, is that right?
Mr. NEILL. Yes, sir, we have.
Mr. BRYANT. As part of your testing that you have done for the
Tier 1 devices, were there any occasions where your own testing
showed non-compliance of the device and the manufacturer had
previously stated that the device was in fact Y2K complaint?
Mr. NEILL. No, sir, I do not recall any of that at all. Our testing
of Tier 1 indicated a failure rate overall of around 2 to 4 percent,
it just depended on which line of the equipment. But we did not,
to the best of my knowledge, discover any malfunctions that had
not already previously been reported by the manufacturer.
Mr. BRYANT. Would you again, for the people who might later see
this program or might be in the audience, distinguish between Tier
1 and Tier 2?
Mr. NEILL. Tier 1, Mr. Chairman, is any device by our definition
that touches a patient that is related to patient safety. A more
prevalent definition throughout the health care industry has been
to call it a mission critical device. A Tier 2 is something other than
a Tier 1. It does not touch a patient. It is not patient safety related.
It is primarily hospital operations and business systems oriented.
Mr. BRYANT. I wonder if all three of the members, and Mr.
Liebler, if you are aware that the FDA has hired outside contrac-
tors to help in assessing the Y2K problem? Has that been of any
help? Was that of any help to you in your own involvement with
this issue?
Mr. HOROWITZ. From the perspective of the manufacturer, we
would have taken any action that we have taken anyway. Just
from the perspective that the devices have to be safe and effective,
we have customers that rely on them. And the fact that FDA hired
consultants to check up on us, really did not factor into our compli-
ance in any way.

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Mr. BRYANT. Mr. Benson or Mr. Liebler?


Mr. LIEBLER. I have spoken with a number of our manufacturers
who did volunteer for these examinations. I asked them to tell me
how they went, and they were very pleased with them.
And I think the most important point they had to mention was,
this is a unique event and a unique situation. They all had worked
very hard and felt that they had done as well as they could. And
this served as a good independent third party who came in and at
least told them they believed they were doing things in the right
way. So I think that was an overall benefit to the industry.
Mr. BRYANT. Mr. Benson, I understand your association rep-
resents about 1,000 manufacturers. I think the total number of
manufacturers registered with the FDA is, I dont see the figure
but it is something like 17,000. I am wondering, too, Mr. Horowitz,
do you represent 100, I think it is
Mr. HOROWITZ. Its 130.
Mr. BRYANT. I assume they are some of the same people, perhaps
cross-pollinating there. But what that tells me is the two of you
represent, in your associations, I dont know where all these other
people go for their representation, but it is a substantial minority.
Is there concern in the industry as a whole on either of your
parts, and Mr. Liebler, I will add you, too, about compliance with
the other manufacturers, non-members?
Mr. BENSON. Let me mention first that HIMAs, if you look at the
HIMA membership in terms of sales, it is almost 90 percent of the
medical device industry.
Mr. BRYANT. I am sorry, you did mention it was 90 percent.
Mr. BENSON. Youve got a slug of MDMA and some of the other
trade associations, NEMA, into that, youre pushing 100 percent.
But there are a lot of small manufacturers, there are a lot of
manufacturers that are classified as startups, or they may not even
have a product on the market. We went out of our way, not only
to push our own members, as did the other associations, but also
to contact non-members. Because we wanted to be responsible citi-
zens and make sure that the industry was in fact doing what it
should do to make sure there was not a Y2K problem.
So I personally feel very strongly that the device industry is in
great shape when it comes, I am not concerned about the fact that
we do not have 100 percent of the companies.
Mr. HOROWITZ. MDMA has done similar things to what HIMA
does. Obviously, membership of MDMA has consisted mostly of
small and startup companies. But we feel the same way that HIMA
does, that in general, these are very highly technologically oriented
companies. And this is not a secret, we have been aware of this for
quite a while and have taken steps to address the problem.
Mr. BRYANT. Since Mr. Brown is here, I am going to go ahead
and ask one or two other questions. We have seized control of the
Chair, so I am very liberal with myself in time.
Could I ask you one general follow-up, to all of you? You were
here when the first panel testified and the inspector general for
HHS, and to some extent the GAO representative testified about
their concern with the, not only liability, but here we are talking
about human lives, their concern at the provider level, where your
product may be testified. And Mr. Neill, you can give us some more

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light on this, because you are kind of at the downstream end of this
more so. But the manufacturers product may testify fine in a lab
setting, but hooked up to everything else in a real world setting,
there might be some problems there.
I would love to have your opinions and your thoughts on those
kinds of comments in the way of giving us some assurance, one
way or the other.
Mr. HOROWITZ. Well, the devices that ANS makes, and the actu-
ally probably the majority of devices that are made by our mem-
bers, are pretty much stand alone devices. They do not interface
with computers or other peoples devices. So the testing that we
conducted would assure the fact that the devices will function as
intended.
To address the other problem, it seems reasonable that if a de-
vice is going to be Y2K compliant, that the output from that device
to another one would also have to be Y2K compliant as well. It
would certainly be prudent on the hospitals part to confirm that,
because there is really no way that the manufacturer of one device
can predict what the product of another manufacturers device will
do, once they interface it. And they are really the only ones that
know how they are using the device.
Mr. NEILL. Mr. Bryant, our organization has elected to confirm
Y2K compliance in the operational environment as opposed to the
lab test environment for the reasons you suggest.
Mr. BRYANT. Thank you. Mr. Benson or Mr. Liebler, any com-
ment?
Mr. LIEBLER. Well, again, I would like to refer to a discussion I
was having yesterday with one of our larger members and the per-
son running their program. He noted that they have structured
their testing as far as they could to make it real world testing.
They understand the concept, you cant put it in a black box and
then say it works when you drop it in the world. So they under-
stand the environments where they are used, and the testing was
designed to make sure that it would work in that environment, and
I am very confident that we are not alone among our companies
doing that.
Mr. BRYANT. Thank you. At this time, the Chair would yield my
time to Mr. Brown, the ranking member.
Mr. BROWN. Thank you, Mr. Chairman.
I asked Mr. Willemssen a question of how he would grade pro-
viders and grade all participants, if you will, for Y2K readiness. I
would like to ask each of you, starting with Mr. Neill, how you
grade your members, your industry, A to F, for Y2K preparedness?
Mr. NEILL. Mr. Brown, it is difficult for me to grade other pro-
viders in the industry. But with your permission, I would be de-
lighted to grade my own organization. We have quite a few hos-
pitals scattered throughout the country. We have made a signifi-
cant investment, as I reported in both written and oral testimony.
We are spending around $20 million on Y2K within Quorum.
And I would give us an A plus. I appreciated the question when
you asked it to panel No. 1. I do think that when you start getting
some responses from the provider community that you are going to
find that more work has been done than perhaps has been reported
overall.

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Mr. BROWN. Mr. Horowitz?


Mr. HOROWITZ. It is a bit difficult for me to speak for the other
members of MDMA. I can speak for us. And obviously, I would give
us an A. We have been at it for quite a while, and we are confident
that everything is fine.
One thing I would like to point out, that we do have to operate
under the quality system regulation which does include design con-
trols. And any prudent medical device manufacturer would include
this type of testing as part of the development and the validation
and verification of any medical device.
So as long as we are following the regulations and our own proce-
dures, I would feel confident that all of the devices would comply
and would not have this problem.
Mr. BROWN. And your grade would be?
Mr. HOROWITZ. Well, if they were doing that, I would give them
an A. But like I said, I do not have the information available to
let you know exactly how the other companies feel about their proc-
ess.
Mr. BROWN. Mr. Benson?
Mr. BENSON. I would give the industry a strong A, A plus.
Mr. BROWN. Because?
Mr. BENSON. Well, as I mentioned in testimony, $700 million has
been spent. I think their reputations are at stake in this. They are
concerned about patient safety. I have seen an enormous effort on
their part to make sure that not only that individual companies,
companies that we have, for example, one of our companies chaired
a committee issue working group that addressed the Y2K, you
know, that leadership has been strong. A lot of activity at the real
working level to make sure that products are in fact compliant, and
that that information is then communicated.
Mr. BROWN. Considering the grades that you each gave your-
selves and your industries, obviously the public, and I guess this
Congress, apparently, the majority, anyway, that scheduled this
hearing does not believe that it is in quite that good a shape. But
the public, in the media, you hear stories that the pacemakers will
stop working after January 1. What message do you have for the
public so that they rest more assured that any kind of tragedies
like this will not happen? Mr. Benson?
Mr. BENSON. That is a good question. I actually think one of the
main problems that has also been addressed that we have not
talked about here is one of distribution. So I think I would reassure
the public that in the medical community, I am not competent to
speak in others, that they recognize that and relax and trust the
system to work.
On a personal note, I do not particularly relish the idea of having
to go to the hospital, but if that were to occur, if it were to occur
to a member of my family, I would not be concerned. I think I
would be very willing to say that.
I think Bernie wants to add something.
Mr. LIEBLER. I think that we are dealing with extremely complex
technology. And I think the pacemaker example that you men-
tioned is an excellent example, because it was the first thing that
I heard about when I started working on Y2K several years ago.

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And it has been very hard to get the message to people that it
is a technology that does not depend on dates. The way I respond
to most reporter questions about that was, does your heart care the
date? Your heart has to beat. And the pacemakers job is to help
your heart beat. And it better not care about what date it is either.
As they refer to in computers, its a 24/7 job.
And it is difficult, it is very difficult for all of us to understand
how computers work, how cell phones work, how medical devices
work. It is daunting. And I think that the best we can do is try
to tell people that the people that work on these, the people that
design these, are good people like they are, working for a good pur-
pose, who want to keep doing it in the future. And they only have
the good of the patient at heart.
Mr. BROWN. Thank you. Thank you, Mr. Chairman.
Mr. BRYANT. Let me thank the panel. You were all very com-
petent and well versed in your expertise, you expressed it well to
us. And you have been very helpful to us, as was the first panel
also very helpful to us.
Since you have all traveled a long way, does anyone have any
closing remarks related to this subject?
[No response.]
Mr. BRYANT. There being none, then, I would assume it is time
to adjourn this hearing. And this hearing is adjourned. Thank you.
[Whereupon, at 12:18 p.m., the subcommittees were adjourned, to
reconvene at the call of their respective Chairs.]

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